Intraoperative Radiation Exposure from O-arm-based 3D Navigation in Spine Surgery
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- Yokota Kazuya
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
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- Kawano Osamu
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Sakai Hiroaki
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Morishita Yuichiro
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Masuda Muneaki
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Hayashi Tetsuo
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Kubota Kensuke
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
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- Hirashima Hideaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University
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- Nakashima Ryota
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University
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- Nakashima Yasuharu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
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- Maeda Takeshi
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
Description
<p>Introduction: Intraoperative three-dimensional (3D) imaging guide technology, such as the O-arm surgical imaging system, is a beneficial tool in spinal surgery that provides real-time 3D images of a patient's spine. This study aims to determine the exposure dose from intraoperative O-arm imaging.</p><p>Methods: A consecutive retrospective review of all patients undergoing spinal surgery was conducted between June 2019 and August 2022. Demographic and operative data were collected from electronic medical records.</p><p>Results: Intraoperative O-arm imaging was conducted in 206 (12.9%) of 1599 patients, ranging from one to 4 scans per patient (1.17±0.43 scans). Single O-arm imaging enabled navigation of seven vertebrae in the cervical spine, seven in the thoracic spine, five in the thoracolumbar spine, and four in the lumbar spine on average. The number of O-arm shots per surgery was 1.15±0.36, 1.06±0.24, 1.61±0.7, and 1.07±0.25 for cervical, thoracic, thoracolumbar, and lumbar spinal cases, respectively. The exposure doses represented by dose length products in single O-arm imaging were 377±19 mGy-cm, 243±22 mGy-cm, 378±38 mGy-cm, and 258±11 mGy-cm for cervical, thoracic, thoracolumbar, and lumbar spine cases, respectively. We observed a weak positive correlation between the number of fused spinal levels and the exposure dose.</p><p>Conclusions: Intraoperative radiation exposure from O-arm imaging was lower than the national diagnostic reference levels in Japan established based on the International Commission on Radiological Protection publication, demonstrating its safety from the standpoint of radiological protection in most cases. In surgeries with a large range of fixations, such as corrective deformity surgery, the number of imaging sessions and the amount of intraoperative radiation exposure would increase, leading surgeons to pay attention to the risk of radiation in spinal surgery.</p>
Journal
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- Spine Surgery and Related Research
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Spine Surgery and Related Research 7 (6), 496-503, 2023-11-27
The Japanese Society for Spine Surgery and Related Research