Intraoperative fluoroscopy, Portable X-ray, and CT: Patient and ... · Background •Intraoperative...
Transcript of Intraoperative fluoroscopy, Portable X-ray, and CT: Patient and ... · Background •Intraoperative...
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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
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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).
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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
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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
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Purpose
•To determine the amount of radiation exposure to patients and operating room staff during spine surgery with C-arm, XR, and O-arm.
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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.
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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
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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
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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
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Results-Patient Exposure
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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
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Results-Surgeon/Staff Exposure
•O-arm scatter is more than XR except for the RT.
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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.
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Thank You to my Co-Authors especially Dr. Klineberg and UC Davis for
supporting this project