Switching to a Pediatr

Alvin W. Su, T. David Luo, Amy L. McIntosh, Beth A. Schueler, Jennifer A. Winkler, Anthony A. Stans, A. Noelle Larson

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Intraoperative computed tomography and image-guided navigation improve the accuracy of screw placement. Radiation exposure to the patient remains a primary drawback. The objective of the present study was to compare the total intraoperative radiation dose and assess the resultant image quality for O-arm-assisted pedicle screw insertion, among 3 protocols: default (manufacturer recommended), institutional (reduced dose utilized in our institution), and pediatric (new protocol with lowest dose). Methods: Thirty-seven consecutive patients under the age of 18 years underwent posterior instrumentation of the spine and underwent an intraoperative O-arm scan. Techniques (kV and mAs) for default and institutional dose settings were manually adjusted based on spinal level and body weight. Pediatric dose techniques were 80 kV/80 mAs with no adjustment for level or weight. The number of scans repeated because of inadequate imaging was assessed, and the mean estimated effective dose between the 3 protocols was compared. Results: Sixty-eight scans were performed in 37 consecutive patients with mean age of 14 years and mean weight of 55 kg. For reference, the effective radiation dose of a chest x-ray is approximately 0.10 mSv. Use of the default protocol resulted in higher mean effective dose per scan of 4.65 mSv, whereas institutional protocol resulted in 2.37 mSv. The pediatric protocol reduced the mean dose to 0.65 mSv. The total effective dose per surgery was: 1.17 mSv (pediatric), 3.83 mSv (institutional), and 12.79 mSv (default) (P<0.0001 each). All scans lead to satisfactory image quality except in 1 patient >100 kg with stainless steel implants. There were no neurological or other implant-related complications. The pediatric protocol resulted in satisfactory image quality with the lowest total radiation dose, only 1/10 of that of the default protocol. Conclusions: We successfully switched to a pediatric low-dose O-arm protocol in clinical practice, reducing the dose to <1/4 of the mean annual natural background radiation. This may allow use of intraoperative computed tomography and navigation for pedicle screw placement without excessive radiation exposure to young patients. Level of Evidence: Level III - retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)621-626
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume36
Issue number6
DOIs
StatePublished - Sep 1 2016

Fingerprint

Pediatrics
Background Radiation
Arm
Radiation
Tomography
Weights and Measures
Stainless Steel
Clinical Protocols
Spine
Thorax
Retrospective Studies
Body Weight
X-Rays
Pedicle Screws
Radiation Exposure

Keywords

  • CT-guided navigation
  • intraoperative CT
  • radiation exposure
  • scoliosis
  • spinal deformity
  • spine surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Orthopedics and Sports Medicine

Cite this

Su, A. W., Luo, T. D., McIntosh, A. L., Schueler, B. A., Winkler, J. A., Stans, A. A., & Larson, A. N. (2016). Switching to a Pediatr. Journal of Pediatric Orthopaedics, 36(6), 621-626. https://doi.org/10.1097/BPO.0000000000000504

Switching to a Pediatr. / Su, Alvin W.; Luo, T. David; McIntosh, Amy L.; Schueler, Beth A.; Winkler, Jennifer A.; Stans, Anthony A.; Larson, A. Noelle.

In: Journal of Pediatric Orthopaedics, Vol. 36, No. 6, 01.09.2016, p. 621-626.

Research output: Contribution to journalArticle

Su, AW, Luo, TD, McIntosh, AL, Schueler, BA, Winkler, JA, Stans, AA & Larson, AN 2016, 'Switching to a Pediatr', Journal of Pediatric Orthopaedics, vol. 36, no. 6, pp. 621-626. https://doi.org/10.1097/BPO.0000000000000504
Su AW, Luo TD, McIntosh AL, Schueler BA, Winkler JA, Stans AA et al. Switching to a Pediatr. Journal of Pediatric Orthopaedics. 2016 Sep 1;36(6):621-626. https://doi.org/10.1097/BPO.0000000000000504
Su, Alvin W. ; Luo, T. David ; McIntosh, Amy L. ; Schueler, Beth A. ; Winkler, Jennifer A. ; Stans, Anthony A. ; Larson, A. Noelle. / Switching to a Pediatr. In: Journal of Pediatric Orthopaedics. 2016 ; Vol. 36, No. 6. pp. 621-626.
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AU - Stans, Anthony A.

AU - Larson, A. Noelle

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N2 - Background: Intraoperative computed tomography and image-guided navigation improve the accuracy of screw placement. Radiation exposure to the patient remains a primary drawback. The objective of the present study was to compare the total intraoperative radiation dose and assess the resultant image quality for O-arm-assisted pedicle screw insertion, among 3 protocols: default (manufacturer recommended), institutional (reduced dose utilized in our institution), and pediatric (new protocol with lowest dose). Methods: Thirty-seven consecutive patients under the age of 18 years underwent posterior instrumentation of the spine and underwent an intraoperative O-arm scan. Techniques (kV and mAs) for default and institutional dose settings were manually adjusted based on spinal level and body weight. Pediatric dose techniques were 80 kV/80 mAs with no adjustment for level or weight. The number of scans repeated because of inadequate imaging was assessed, and the mean estimated effective dose between the 3 protocols was compared. Results: Sixty-eight scans were performed in 37 consecutive patients with mean age of 14 years and mean weight of 55 kg. For reference, the effective radiation dose of a chest x-ray is approximately 0.10 mSv. Use of the default protocol resulted in higher mean effective dose per scan of 4.65 mSv, whereas institutional protocol resulted in 2.37 mSv. The pediatric protocol reduced the mean dose to 0.65 mSv. The total effective dose per surgery was: 1.17 mSv (pediatric), 3.83 mSv (institutional), and 12.79 mSv (default) (P<0.0001 each). All scans lead to satisfactory image quality except in 1 patient >100 kg with stainless steel implants. There were no neurological or other implant-related complications. The pediatric protocol resulted in satisfactory image quality with the lowest total radiation dose, only 1/10 of that of the default protocol. Conclusions: We successfully switched to a pediatric low-dose O-arm protocol in clinical practice, reducing the dose to <1/4 of the mean annual natural background radiation. This may allow use of intraoperative computed tomography and navigation for pedicle screw placement without excessive radiation exposure to young patients. Level of Evidence: Level III - retrospective comparative study.

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