Augmented Reality Surgical Navigation in Spine Surgery to Minimise Staff Radiation Exposure

2019-10-29

In this study, the authors assessed staff and patient radiation exposure during augmented reality surgical navigation (ARSN) in spine surgery. Surgical navigation in combination with intraoperative 3D imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement. Although this technique may increase the total radiation exposure compared to fluoroscopy, the occupational exposure can be minimised, as navigation is radiation free and staff can be positioned behind protective shielding during 3D 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 (APD) 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??Sv. 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 CBCT 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 to values reported in literature. Real-time APD contributed to a fast optimisation and adoption of protective measures throughout the study. Even though the data include both CBCT for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared to published data.

Authors: Edström E, Burström G, Omar A, Nachabe R, Söderman M, Persson O, Gerdhem P, Elmi A.
; Full Source: Spine (Phila Pa 1976). 2019 Aug 13. doi: 10.1097/BRS.0000000000003197. [Epub ahead of print]