Comparison of Radiation Exposure of AIRO Intraoperative CT with C-Arm Fluoroscopy during Posterior Lumbar Interbody Fusion

Navigation systems used during minimally invasive spine procedures have evolved from uniplanar, two-dimensional C-arm fluoroscopy to multiplanar, 3D intraoperative computed tomography (iCT). In this study, the radiation exposure to the patient and operating room staff in posterior intervertebral lumbar fusion procedures is compared between iCT and C-arm fluoroscopy. The effective dose of the surgeon, operating nurse, and anesthesiologist was measured during surgery with personal dosimeters, and the effective dose of the patient was measured with Gafchromic(TM) films. The time efficiency of the procedure was evaluated by recording the duration of pedicle screw fixation and the duration of the total surgery time. A total of 75 patients participated in the study; 30 patients had surgery guided by iCT and 45 by C-arm fluoroscopy. The radiation dose of the surgeon, the operating nurse, and the anesthesiologist was thirteen fold lower with surgeries assisted by iCT compared to C-arm fluoroscopy. In contrast, the effective dose of the patient significantly increased with iCT. Using iCT, radiation exposure of the operating room staff can be significantly reduced. iCT increases the effective dose of the patient and prolongs the operative time.