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Cervical Spine Imaging Using Standard C-Arm Fluoroscopy: Patient and Surgeon Exposure to Ionizing Radiation

Giordano, Brian D. MD*; Baumhauer, Judith F. MD*; Morgan, Thomas L. PhD; Rechtine, Glenn R. MD*

doi: 10.1097/BRS.0b013e31817e69b7
Cervical Spine

Study Design. A cadaveric cervical spine specimen is imaged with a standard C-arm fluoroscope during a simulated procedure. Patient and surgeon exposure to radiation is estimated by placing dosimeters at various locations in 3-dimensional space.

Objective. The purpose of this study was to evaluate radiation exposure to patient and surgeon when using C-arm fluoroscopy during a simulated cadaveric surgical procedure involving the cervical spine.

Summary of the Background Data. The use of mobile fluoroscopy has become commonplace in orthopaedics. With the current trend towards minimal access techniques, fluoroscopy has become requisite to achieving satisfactory outcomes. Studies have shown that spine surgeons may be at elevated risk for radiation exposure compared to other orthopaedists. Exposure while using C-arm fluoroscopy for procedures involving the pelvis, as well as thoracic and lumbar spine has been documented. However, there are no equivalent studies that evaluate exposure during cervical spine imaging.

Methods. A standard OEC 9800 C-arm was used to image a prepared cadaveric cervical spine specimen, which was suspended on an adjustable platform. Film badge dosimeters were mounted at various positions and angles to detect direct and scatter radiation. Testing was conducted in various radiation dose mapping “scenarios.” The configurations tested altered the proximity of the specimen and jig relative to the radiation source. We attempted to capture radiation exposure in various locations, from a best-case to a worst-case scenario, as may be realistically encountered in a procedural setting.

Results. Potential exposure to the patient and surgeon were consistently measurable, and of concern. As the imaged specimen was positioned closer to the radiation source, exposure to the patient was markedly amplified. Exposure to the surgeon did not increase as dramatically. There was a great degree of variability in the exposure doses recorded by the peripheral dosimeters. Even dosimeters that were placed in the same plane diverged widely in their measured exposure. This highlights the influence of the shape of the imaged specimen on reflected scatter. Scatter radiation doses on both sides of the specimen were similar.

Conclusion. Care should be taken when working on both sides of the imaged subject. Considerable radiation exposure can be encountered when working with a C-arm fluoroscope if appropriate precautions are not observed. All appropriate radiation dose–reducing measures should be strictly enforced by the supervising physician to minimize risk to the patient and the medical team.

C-arm fluoroscopes can produce considerable radiation exposure if used in an injudicious manner. Spine surgeons, in particular, may be at an elevated risk for excessive exposure. All appropriate radiation dose–reducing measures should be strictly enforced by the supervising physician to minimize risk to the patient and the medical team. Radiation physics and safety should be incorporated into standard spine surgery training.

From the *Department of Orthopedics and Rehabilitation, and †Radiation Safety Unit, University of Rochester Medical Center, Rochester, NY.

Acknowledgment date: February 5, 2008. Revision date: March 24, 2008. Acceptance date: April 8, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Glenn R. Rechtine, MD, 601 Elmwood Ave, Box 665, Rochester, NY 14642; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.