Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine

Study Design. An experimental model to assess radiation exposure during lumbar pedicle screw insertion. Objectives. To measure skin (patient) and scatter (surgeon) doses of radiation during lumbar spine fluoroscopy to assess safety of the procedure for both the surgeon and patient and determine best practice; Summary of Background Data. Fluoroscopy assists with accuracy of pedicle screw placement, yet the optimal technique of C-arm use and risk to both patient and operating room staff from radiation exposure are unknown. Methods. Entry- and scatter-dose recordings were made using a digital dosimeter while screening an anthropomorphic phantom prone on a radiolucent operating table. The source was positioned both superiorly and inferiorly with the height varied in the latter orientation to create a working space under the C-arm. The senior author's fluoroscopy records were reviewed in 140 consecutive cases. Results. In a series of 140 patients who underwent pedicle screw fixation, the fluoroscopy time was 1.4 minutes per case or 0.33 minutes per screw. In the source-superior position, the effective dose received by the patient was approximately 2.3 mSv per case. In the source-inferior position with a working space of 300 mm, the effective dose was 6.8 mSv. Scatter dose to the surgeon was higher in the source-superior position but was still less than 10% of recommended limits for the hand, thyroid, and eyes. Conclusions. The source-superior position is the preferred position for pedicle screw screening if a working space is required. Patient exposure is minimized, and surgeon dose is well within current recommendations.