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  • Accuracy, Radiation Time, and Radiation Exposure Using Computer-Assisted Instrument Navigation vs. Conventional C-Arm Fluoroscopy for Spine Surgery Instrumentation

    Final Number:

    Timothy Y. Wang MD; Farah Hamouda; Eric W. Sankey MD; Vikram Mehta MPH, MD; Juan S. Uribe MD; Chester Yarbrough MD MPHS; Muhammad M Abd-El-Barr MD PhD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Surgical instruments, especially during minimally invasive procedures, must be repositioned multiple times throughout an intervention and are often adjusted repeatedly until the physician is satisfied with placement. This increases radiation exposure to both surgeon and patient. Ultra-low radiation imaging coupled with image enhancement and optical instrument tracking (ULRI-IE/IT) allows a computer to show real-time movement of the instrument as it is adjusted, mimicking live fluoroscopy. This has the potential to drastically reduce intraoperative radiation reduction.

    Methods: A cadaveric study was undertaken. Physicians from various specialties were asked to identify the ideal location for instrumentation for various spine, orthopedic, pain management, and physiatry procedures and then place an instrument to this location both with and without computer assistance, randomly assigned to reduce the impact of learning. Number of x-rays, radiation exposure and time to perform each procedure was recorded.

    Results: Twenty-three trials of 9 procedures by 5 physicians were completed both with and without the assistance of ULRI-IE/IT, ranging from percutaneous pedicle screws to foramen ovale ablation. Total time to localize for all 23 cases was 31.2% longer without assistance. ULRI-IE/IT reduced the total number of x-rays by 74.8% and radiation exposure by 91.8%. Statistically significant radiation reduction was experienced for every procedure. With ULRI-IE/IT, physicians were able to successfully place the instrument in the correct location on the first attempt in 82.6% of trials and by the second attempt in 100% of trials. With standard fluoroscopy, physicians were never able on the first attempt and required an average of 4.65 images to achieve accurate placement.

    Conclusions: Ultra-low radiation imaging with image enhancement and instrument tracking is able to dramatically reduce the number of unnecessary images taken when performing a fluoroscopic procedure. Overall, this resulted in 91.8% radiation reduction and a significant time savings.

    Patient Care: The technology described in this abstract/manuscript is an FDA approved adjunct to the standard C-arm fluoroscope. Through this abstract, we were able to demonstrate significant reduction in intraoperative radiation exposure with the usage of this technology. By reducing intraoperative reduction, we can reduce the deleterious health effects of radiation exposure for not only the patient but also the surgeon and operating room staff.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of reducing intraoperative radiation exposure, 2) Discuss, in small groups, the utility of ultra-low radiation imaging with image enhancement and instrument tracking, and 3) Identify ultra-low radiation imaging with image enhancement and instrument tracking as an effective method of reducing intraoperative radiation exposure and improving surgeon accuracy and efficiency.


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