Augmented Reality Surgical Navigation in Spine Surgery to Minimize Staff Radiation Exposure.
Adult
Augmented Reality
Cone-Beam Computed Tomography
/ methods
Female
Fluoroscopy
/ methods
Humans
Imaging, Three-Dimensional
/ methods
Male
Occupational Exposure
Pedicle Screws
Prospective Studies
Radiation Dosage
Radiation Exposure
/ statistics & numerical data
Spine
/ surgery
Surgery, Computer-Assisted
/ methods
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jan 2020
01 Jan 2020
Historique:
pubmed:
16
8
2019
medline:
18
3
2020
entrez:
16
8
2019
Statut:
ppublish
Résumé
Prospective observational study. To assess staff and patient radiation exposure during augmented reality surgical navigation in spine surgery. Surgical navigation in combination with intraoperative three-dimensional imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement. Although this technique may increase the total radiation exposure compared with fluoroscopy, the occupational exposure can be minimized, as navigation is radiation free and staff can be positioned behind protective shielding during three-dimensional imaging. The patient radiation exposure during treatment and verification of pedicle screw positions can also be reduced. Twenty patients undergoing spine surgery with pedicle screw placement were included in the study. The staff radiation exposure was measured using real-time active personnel dosimeters and was further compared with measurements using a reference dosimeter attached to the C-arm (i.e., a worst-case staff exposure situation). The patient radiation exposures were recorded, and effective doses (ED) were determined. The average staff exposure per procedure was 0.21 ± 0.06 μSv. The average staff-to-reference dose ratio per procedure was 0.05% and decreased to less than 0.01% after a few procedures had been performed. The average patient ED was 15.8 ± 1.8 mSv which mainly correlated with the number of vertebrae treated and the number of cone-beam computed tomography acquisitions performed. A low-dose protocol used for the final 10 procedures yielded a 32% ED reduction per spinal level treated. This study demonstrated significantly lower occupational doses compared with values reported in the literature. Real-time active personnel dosimeters contributed to a fast optimization and adoption of protective measures throughout the study. Even though our data include both cone-beam computed tomography for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared with published data. 3.
Sections du résumé
STUDY DESIGN
METHODS
Prospective observational study.
OBJECTIVE
OBJECTIVE
To assess staff and patient radiation exposure during augmented reality surgical navigation in spine surgery.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Surgical navigation in combination with intraoperative three-dimensional imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement. Although this technique may increase the total radiation exposure compared with fluoroscopy, the occupational exposure can be minimized, as navigation is radiation free and staff can be positioned behind protective shielding during three-dimensional imaging. The patient radiation exposure during treatment and verification of pedicle screw positions can also be reduced.
METHODS
METHODS
Twenty patients undergoing spine surgery with pedicle screw placement were included in the study. The staff radiation exposure was measured using real-time active personnel dosimeters and was further compared with measurements using a reference dosimeter attached to the C-arm (i.e., a worst-case staff exposure situation). The patient radiation exposures were recorded, and effective doses (ED) were determined.
RESULTS
RESULTS
The average staff exposure per procedure was 0.21 ± 0.06 μSv. The average staff-to-reference dose ratio per procedure was 0.05% and decreased to less than 0.01% after a few procedures had been performed. The average patient ED was 15.8 ± 1.8 mSv which mainly correlated with the number of vertebrae treated and the number of cone-beam computed tomography acquisitions performed. A low-dose protocol used for the final 10 procedures yielded a 32% ED reduction per spinal level treated.
CONCLUSION
CONCLUSIONS
This study demonstrated significantly lower occupational doses compared with values reported in the literature. Real-time active personnel dosimeters contributed to a fast optimization and adoption of protective measures throughout the study. Even though our data include both cone-beam computed tomography for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared with published data.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 31415457
doi: 10.1097/BRS.0000000000003197
pii: 00007632-202001010-00018
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E45-E53Références
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