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J Neurosurg Spine. 2016 Nov;25(5):654-659. Epub 2016 Jun 24.

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

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Neurosurgery Department.
Health Physics, and.
Neuroradiology Department, Humanitas Clinical and Research Center, Rozzano; and.
Istituto Galeazzi, IRCCS, Milan, Italy.


OBJECTIVE The O-arm system in spine surgery allows greater accuracy, lower rate of screw misplacement, and reduced surgical time. Some concerns have been postulated regarding the radiation doses to patients and surgeons. To the best of the authors' knowledge, most of the studies in the literature were performed with the use of phantoms. The authors present data regarding radiation exposure of the surgeon and operating room (OR) staff in a consecutive series of patients undergoing spine surgery. METHODS Radiation exposure data were collected in a series of 107 patients who underwent spine surgery using the O-arm system. The doses received by the surgeon and the staff were collected using electronic dosimeters. RESULTS All patients underwent 1-3 scans. The mean radiation dose to the patients was 5.15 mSv (range 1.48-7.64 mSv). The mean dose registered for the scan operator was 0.005 μSv (range 0.00-0.03 μSv) while the other members of the surgical team positioned outside the OR received 0 μSv. CONCLUSIONS The O-arm system exposes patients to a higher radiation dose than standard fluoroscopy. However, considering the clear advantages of this system, this adjunctive dose can be considered acceptable. Moreover, the effective dose to the patient can be reduced using collimation or minimizing the parameters of the O-arm system used in this paper. The exposure to operators is essentially negligible when radioprotective garments and protocols are adopted as recommended by the International Commission on Radiological Protection.


BMI = body mass index; CTDI = CT dose index; DLP = dose length product; ICRP = International Commission on Radiological Protection; IGS = image-guided system; O-arm system; OR = operating room; dosimetry; navigation; radiation dose; spine surgery; technique

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