Abstract
Careful protocol selection is required during intraoperative three‐dimensional (3D) imaging for spine surgery to manage patient radiation dose and achieve clinical image quality. Radiation dose and image quality of a Medtronic O‐arm commonly used during spine surgery, and a Philips hybrid operating room equipped with XperCT C‐arm 3D cone‐beam CT (hCBCT) are compared. The mobile O‐arm (mCBCT) offers three different radiation dose settings (low, standard, and high), for four different patient sizes (small, medium, large, and extra large). The patient's radiation dose rate is constant during the entire 3D scan. In contrast, C‐CBCT spine imaging uses three different field of views (27, 37, and 48 cm) using automatic exposure control (AEC) that modulates the patient's radiation dose rate during the 3D scan based on changing patient thickness. hCBCT uses additional x‐ray beam filtration. Small, medium, and large trunk phantoms designed to mimic spine and soft tissue were imaged to assess radiation dose and image quality of the two systems. The estimated measured “patient” dose for the small, medium, and large phantoms imaged by the mCBCT considering all the dose settings ranged from 9.4–27.6 mGy, 8.9–33.3 mGy, and 13.8–40.6 mGy, respectively. The “patient” dose values for the same phantoms imaged with hCBCT were 2.8–4.6 mGy, 5.7–10.0 mGy, and 11.0–15.2 mGy. The CNR for the small, medium, and large phantoms was 2.9 to 3.7, 2.0 to 3.0, and 2.5 to 2.6 times higher with the hCBCT system, respectively. Hounsfield unit accuracy, noise, and uniformity of hCBCT exceeded the performance of the mCBCT; spatial resolution was comparable. Added x‐ray beam filtration and AEC capability achieved clinical image quality for intraoperative spine surgery at reduced radiation dose to the patient in comparison to a reference O‐arm system without these capabilities.
Highlights
Pedicle screw malposition can lead to various complications such as vascular and visceral structure damage, or dural lesions and radiculopathy, which might require revision surgery.[1]
The patient dose index range for the small, medium, and large CIRS phantoms imaged by the mCBCT for low dose (LD), standard dose (SD), and high dose (HD) was 9.4– 27.6 mGy, 8.9–33.3 mGy, and 13.8–40.6 mGy, respectively
The patient dose index range for the same phantoms imaged by the hCBCT unit for 27, 37, and 48 cm field of view (FoV) ranged from 2.8–4.6 mGy, 5.7–10.0 mGy, and 11.0–15.2 mGy, respectively
Summary
Pedicle screw malposition can lead to various complications such as vascular and visceral structure damage, or dural lesions and radiculopathy, which might require revision surgery.[1]. Image‐guided spine surgery using intraoperative three‐dimensional (3D)‐based navigation increases clinical accuracy of pedicle screw placement compared to free‐hand or fluoroscopy‐guided placement. In order to perform a spine surgery with navigation, an intraoperative 3D scan of the spinal region of interest is performed to use during navigation for localization of the instruments in the various 3D planes. At the end of the procedure, a second intraoperative 3D scan can be performed to assess the correct placement of introduced hardware as an alternative to radiographs or postoperative CT. Regardless of which type of camera navigation is used, it was demonstrated that the image quality of the intraoperative 3D scan can influence the accuracy of navigation.[6,7]
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