Patient Dose Comparison for Intraoperative Imaging Devices Used in Orthopaedic Lumbar Spinal Surgery.

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Background:The aim of this study was to determine the amount of radiation exposure from intraoperative imaging during two-level and four-level lumbar fusions. Methods:Five imaging systems were studied: multidetector CT (MDCT) scanner (CT A); two mobile CT units (CT B and CT C); a C-arm (D); and fluoroscopy (E). Metal oxide semiconductor field effect transistor dosimeters measured doses at 25 organ locations using an anthropomorphic phantom. A fat-equivalent phantom was used to simulate an obese body mass index (BMI). Results:The effective dose (ED) for C-arm D was estimated using commercial software. The ED for others was computed from the measured mean organ doses. EDs for a normal BMI patient, receiving a four-level fusion, are as follows: CT A (12.00 ± 0.30 mSv), CT B (5.90 ± 0.25 mSv), CT C (2.35 ± 0.44 mSv), C-arm D (0.44 mSv), and fluoroscopy E (0.30 ± 0.3 mSv). The rankings are consistent across all three BMI values except CT C and fluoroscopy E, which peaked in the overweight size because of system limitations. The other machines' ED trended with patient BMI. Conclusion:The dose reduction protocols were confirmed according to the manufacturer's specifications. The results of this study emphasize the need for the appropriate selection of the imaging system, especially because the type of device could have a substantial effect on patient radiation risk.






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Foster, NA, Bria Moore, Ronald Womack, Giao Nguyen, William Richardson and Terry Yoshizumi (2018). Patient Dose Comparison for Intraoperative Imaging Devices Used in Orthopaedic Lumbar Spinal Surgery. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2(7). p. e030. 10.5435/JAAOSGlobal-D-18-00030 Retrieved from

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William James Richardson

Professor of Orthopaedic Surgery
  1. Current research includes investigation of biomechanical aspects of cervical injury with head impact. This involves cadaveric work with high-speed photography and load cells to ascertain the mechanism for spinal fractures.

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    5. Current work is ongoing to develop an outcomes instrument and database to be used in the outpatient setting for patients with spinal complaints, both cervical and lumbar. The device will be used to evaluate clinical effectiveness for a variety of treatments for spinal conditions and to look at patient satisfaction issues.

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