Significant Reduction of Radiation Exposure Using Specific Settings of the O-Arm for Percutaneous Cementoplasty in Accordance With the ALARA Principle

Marc Prod'homme; Didier Grasset; Alain Akiki; Lionel Helfer; Gilles Dietrich; Jonas Pierre Müller; Mattia Tomasoni; Mahmoud Sellami; Duccio Boscherini

doi:10.14444/8477

Significant Reduction of Radiation Exposure Using Specific Settings of the O-Arm for Percutaneous Cementoplasty in Accordance With the ALARA Principle

Int J Spine Surg. 2023 Aug;17(4):534-541. doi: 10.14444/8477. Epub 2023 May 30.

Authors

Marc Prod'homme^{1

2}, Didier Grasset³, Alain Akiki², Lionel Helfer², Gilles Dietrich^{2

4}, Jonas Pierre Müller², Mattia Tomasoni⁵, Mahmoud Sellami⁵, Duccio Boscherini^{3

2}

Affiliations

¹ Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland marcprod86@gmail.com.
² Orthopedic Surgery Department, Riviera-Chablais Hospital, Rennaz, Switzerland.
³ Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland.
⁴ Orthopedic Surgery Department, Lausanne University Hospital, Lausanne, Switzerland.
⁵ Ophtalmology Department, Jules-Gonin University Eye Hospital, University of Lausanne, Lausanne, Switzerland.

PMID: 37253626
PMCID: PMC10478703
DOI: 10.14444/8477

Abstract

Background: Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use of imaging is an unresolved issue, and information about it is relatively scarce. The "as low as reasonably achievable" (ALARA) principle aims to reduce the radiation exposure for the patients as low as possible. The objective of this study was to compare the effective dose related to the use of the O-arm in standard settings with adapted features for dose reduction during percutaneous cementoplasty.

Methods: From March 2021 to October 2022, all consecutive patients who underwent navigated percutaneous cementoplasty with the use of the O-arm were prospectively included. Demographic, operative, irradiation, and radiological data were collected. The main outcome was the effective dose (E) in millisievert (mSv). Secondary outcomes were the absolute risk of cancer (AR) in percent equivalent to a whole-body exposition, operative time, and radiological results according to Garnier. In group A, patients were operated on with standard settings of the O-arm, whereas in group B, navigation on the field of view, collimation, and low-dose settings were used.

Results: A total of 70 patients were included in the study: 43 in group A and 27 in group B. Also, 109 vertebrae were operated: 59 in group A and 50 in group B. Mean E was significantly higher in group A than in group B (9.94 and 4.34 mSv, respectively; P < 0.01). The 3D-related E followed the same trend (7.82 and 3.97 mSv, respectively), as did 2-dimensional-related E (2.12 and 0.37 mSv, respectively; P < 0.01). Average AR was also significantly higher in group A than in group B (5.10^-4% and 2.10^-4% respectively; P < 0.01). Operative time was similar in both groups, but the rate of satisfactory radiological results was higher in group A than in group B (95% and 84%, respectively; P = 0.11), and we found similar rates of cement leakage (22% and 24%, respectively; P = 0.71).

Conclusions: The application of settings of the O-arm in accordance with the ALARA principle helped to significantly reduce the radiation exposure and should be routinely used for O-arm-assisted cementoplasty procedures.

Clinical relevance: This study details technical aspects and settings that may help users of the O-arm to decrease radiation exposure to patients and surgeons alike, especially in cementoplasty procedures, as well as in other procedures performed under O-arm guidance.

Keywords: ALARA principle; O-arm; kyphoplasty; radiation exposure; vertebroplasty.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.