Intraoperative fluoroscopy, Portable X-ray, and CT:

Patient and OperatingRoom Personnel Radiation Exposure in Spinal Surgery

Presented by Shafagh Monazzam MDCo-Authors

Elisha Nelson ARRT, Kee D. Kim MD, Anthony Seibert PHD and Eric Klineberg MD

Background•Intraoperative imaging is essential in spinal surgery to both determine the correct level and place implants safely.

•Multiple Modalities:•C-arm fluoroscopy(C-arm)•Portable X-ray (XR) radiography, •Portable cone-beam computed tomography (O-arm).

Background

•Radiation exposures continues to evolve as a concern for patients, staff and the physician.

•No direct comparison of radiation exposure to patient and staff between all three modalities

Background

•Radiation exposures continues to evolve as a concern for patients, staff and the physician.

•No direct comparison of radiation exposure to patient and staff between all three modalities

Purpose

•To determine the amount of radiation exposure to patients and operating room staff during spine surgery with C-arm, XR, and O-arm.

Methods•We created a surrogate patient phantom comprised of 12x12x3/8 inch polymethylmethacrylate which emulated the volume and absorption scattering characteristics of a typical sized adult abdominal volume.

Methods•We took single shots of C-arm, XR, O-

arm.•We measured Radiation exposure to

the patient using a calibrated RadcalAccu-pro #9096 dosimeter/ionization chamber instrument

Methods• We also measured scatter radiation at 3 height levels (eye, chest, legs) in four

typical standing positions for C-arm AP and Lateral images

• Each spot correspond to where the following would be standing during typical C-arm use:

• Surgeon assistant

• Radiology Technologist

• Anesthesiologist

• Surgeon

Methods•Again, we measured scatter radiation at 3 height levels (eye, chest, legs) in 4 spots for O-arm and XR

•Typical standing positions were emulated, in addition to in front of the radiation shield

Results-Patient Exposure

Results-Surgeon/Staff Exposure•One key result, is radiation is on average 8.3x more on the anode side then the intensifier side!

•For context, 5,000 mRem a year is maximum for occupational workers

Results-Surgeon/Staff Exposure

•O-arm scatter is more than XR except for the RT.

Conclusion

•Radiation exposure is significant in portable XR, with one lateral image is equivalent to 30 C-arm images!

•There is significant scatter radiation and either a shield should be utilized or lead should be worn

•This data will hopefully help the surgeon understand the radiation exposure to the patient when choosing between modalities.

Thank You to my Co-Authors especially Dr. Klineberg and UC Davis for

supporting this project