Klingler Jan-Helge, Sircar Ronen, Scheiwe Christian, Kogias Evangelos, Krüger Marie T, Scholz Christoph, Hubbe Ulrich
Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany.
Clin Spine Surg. 2017 Jul;30(6):E669-E676. doi: 10.1097/BSD.0000000000000187.
A radiation exposure study in vitro.
This study aimed to compare the radiation exposure of 2 different 3-dimensional (3D) C-arm devices on an anthropomorphic phantom.
Minimally invasive pedicle screw placement requires intraoperative imaging techniques for visualization of the unexposed spine. Mobile 3D C-arms compose a 3D image data set out of multiple successive fluoroscopic images.
We compared the 3D C-arm devices Siremobil Iso-C 3D (Siemens Sector Healthcare, Erlangen, Germany) and Vision FD Vario 3D (Ziehm Imaging, Nuremberg, Germany) regarding their radiation exposure. For this purpose, dosimeters were attached on an anthropomorphic phantom at various sites (eye lenses, thyroid gland, female, and male gonads). With each C-arm, 10 automated 3D scans as well as 400 fluoroscopic images were performed on the cervical and lumbar spine, respectively.
The Vision FD Vario 3D generally causes higher radiation exposures than the Siremobil Iso-C 3D. Significantly higher radiation exposures were assessed at the eye lenses performing cervical (294.1 vs. 84.6 μSv) and lumbar 3D scans (22.5 vs. 11.2 μSv) as well as at the thyroid gland performing cervical 3D scans (4405.2 vs. 2761.9 μSv). Moreover, the Vision FD Vario 3D caused significantly higher radiation exposure at the eye lenses for standard cervical fluoroscopic images (3.2 vs. 0.4 μSv).
3D C-arms facilitate minimally invasive and accurate pedicle screw placement by providing 3D image datasets for intraoperative 3D imaging and navigation. However, the hereby potentially increased radiation exposure has to be considered. In particular, the Vision FD Vario 3D appears to generally evoke higher radiation exposures than the Siremobil Iso-C 3D. Well-indicated application of ionizing radiation and compliance with radiation protection principles remain mandatory to keep radiation exposure to patient and staff as low as reasonably achievable.
一项体外辐射暴露研究。
本研究旨在比较两种不同的三维（3D）C形臂设备在人体模型上的辐射暴露情况。
微创椎弓根螺钉置入需要术中成像技术来可视化未暴露的脊柱。移动3D C形臂由多个连续的荧光透视图像组成三维图像数据集。
我们比较了Siremobil Iso-C 3D（德国埃尔兰根西门子医疗部门）和Vision FD Vario 3D（德国纽伦堡齐默成像公司）这两种3D C形臂设备的辐射暴露情况。为此，将剂量计附着在人体模型的不同部位（晶状体、甲状腺、女性和男性性腺）。使用每种C形臂，分别在颈椎和腰椎进行10次自动3D扫描以及400次荧光透视成像。
Vision FD Vario 3D通常比Siremobil Iso-C 3D产生更高的辐射暴露。在进行颈椎（294.1对84.6微希沃特）和腰椎3D扫描时，晶状体处的辐射暴露评估显著更高（22.5对11.2微希沃特），以及在进行颈椎3D扫描时甲状腺处的辐射暴露也显著更高（4405.2对2761.9微希沃特）。此外，对于标准颈椎荧光透视图像，Vision FD Vario 3D在晶状体处引起的辐射暴露显著更高（3.2对0.4微希沃特）。
3D C形臂通过为术中3D成像和导航提供3D图像数据集，有助于微创且准确地置入椎弓根螺钉。然而，必须考虑由此可能增加的辐射暴露。特别是，Vision FD Vario 3D似乎通常比Siremobil Iso-C 3D引起更高的辐射暴露。合理使用电离辐射并遵守辐射防护原则仍然是必要的，以将患者和工作人员的辐射暴露保持在合理可及的最低水平。
