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Radiation Exposure to the Spine Surgeon in Lumbar and Thoracolumbar Fusions With the Use of an Intraoperative Computed Tomographic 3-Dimensional Imaging System

Abdullah, Kalil G., BS*,†,‡; Bishop, Frank S., MD; Lubelski, Daniel, BA*,†,‡; Steinmetz, Michael P., MD§,¶; Benzel, Edward C., MD*,†,‡; Mroz, Thomas E., MD*,†,‡,‖

doi: 10.1097/BRS.0b013e31825786d8
Diagnostics
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Study Design. A prospective clinical research article.

Objective. The primary goals were to determine (1) radiation exposure to the spine surgeon with the use of an intraoperative 3-dimensional imaging system and (2) to define the safe distance from the computed tomographic scanner.

Summary of Background. Intraoperative radiation exposure to the spinal surgeon has been assessed during 2-dimensional fluoroscopy but has not been investigated during intraoperative 3-dimensional imaging.

Methods. Ten patients undergoing lumbar or thoracolumbar fusion were enrolled in a prospective trial to determine the radiation exposure to a spine surgeon standing in the substerile room, with the use of the O-ARM Imaging System (Medtronic, Memphis, TN). A thermolucent digital dosimeter was worn at chest level without a lead apron. Dosimeter readings and distance from the spine surgeon were recorded.

Results. Average surgeon exposure was 44.22 ± 17.4 μrem (range: 17.71–70.76 μrem). The mean distance from the O-ARM was 4.56 ± .32 m, and the surgeon was exposed for an average of 19.6 ± 5.7 seconds (range: 8.05–28.7 s). The annual number of necessary procedures required to surpass the exposure limit, according to the data presented here, would be 113,071 operations using O-ARM. Hence, the number of necessary procedures for O-ARM use is predicted to be 1,130,710 annual procedures to reach the occupational exposure limits for extremity, skin, and all other organs and 339,213 procedures to reach the limits for the lens of eye.

Conclusion. Radiation exposure is minimal to the surgical team during routine use of the O-ARM imaging system. The number of procedures required to surpass occupational exposure limits is high if using appropriate distance from the O-ARM.

This study is the first to measure radiation exposure to the surgeon with the use of the O-ARM imaging system. Average surgeon exposure was 44.22 ± 17.4 μrem. The annual number of necessary procedures required to surpass the exposure limit would be 113,071 operations using O-ARM.

*Cleveland Clinic Lerner College of Medicine, Cleveland, OH

Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH

Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH

§MetroHealth Medical Center, Cleveland, OH

Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Thomas E. Mroz, MD, Neurological Institute, Cleveland Clinic Center for Spine Health, Departments of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-40, Cleveland, OH 44195; E-mail: mrozt@ccf.org

Acknowledgment date: October 11, 2011. First revision date: February 11, 2012. Second revision date: March 7, 2012. Acceptance date: March 16, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

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.

© 2012 Lippincott Williams & Wilkins, Inc.