Dose Optimisation for Intraoperative Cone-beam Flat-detector CT in Paediatric Spinal Surgery

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2012 Jun 7

PMID 22669457

Citations 7

Authors

Asger Greval Petersen

Soren Eiskjaer

Jon Kaspersen

Affiliations

Soon will be listed here.

Abstract

Background: During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT.

Objective: The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle.

Materials And Methods: Using O-arm® (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDI(w) doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children.

Results: The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDI(w) doses 89-93%. The effective dose was 0.5 mSv (91-94,5% reduction). The optimised protocols were used clinically without problems.

Conclusions: Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws.

Citing Articles

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems.

Nachabe R, Strauss K, Schueler B, Bydon M J Appl Clin Med Phys. 2019; 20(2):136-145.

PMID: 30677233 PMC: 6370984. DOI: 10.1002/acm2.12534.

Intraoperative 2D C-arm and 3D O-arm in children: a comparative phantom study.

Prodhomme M, Sans-Merce M, Pitteloud N, Damet J, Lascombes P J Child Orthop. 2018; 12(5):550-557.

PMID: 30294382 PMC: 6169555. DOI: 10.1302/1863-2548.12.180016.

A novel technique of cervical pedicle screw placement with a pilot screw under the guidance of intraoperative 3D imaging from C-arm cone-beam CT without navigation for safe and accurate insertion.

Takahata M, Yamada K, Akira I, Endo T, Sudo H, Yokoyama H Eur Spine J. 2018; 27(11):2754-2762.

PMID: 30039255 DOI: 10.1007/s00586-018-5706-x.

Ionizing radiation exposure: hazards, prevention, and biomarker screening.

Mu H, Sun J, Li L, Yin J, Hu N, Zhao W Environ Sci Pollut Res Int. 2018; 25(16):15294-15306.

PMID: 29705904 DOI: 10.1007/s11356-018-2097-9.

Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures.

Eckardt H, Lind D, Toendevold E Acta Orthop. 2015; 86(6):684-9.

PMID: 26012545 PMC: 4750767. DOI: 10.3109/17453674.2015.1055690.

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