Montefiore Medical Center, Bronx, NY.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2020 Nov 15;45(22):E1507-E1515. doi: 10.1097/BRS.0000000000003650.
Cross-sectional survey.
Examine patients' and physicians' estimates of radiation exposure related to spine surgery.
Patients are commonly exposed to radiation when undergoing spine surgery. Previous studies suggest that patients and physicians have limited knowledge about radiation exposure in the outpatient setting. This has not been assessed for intraoperative imaging.
A questionnaire was developed to assess awareness/knowledge of radiation exposure in outpatient and intraoperative spine care settings. Patients and surgeons estimated chest radiograph (CXR) equivalent radiation from: cervical and lumbar radiographs (anterior-posterior [AP] and lateral), computed tomography (CT), magnetic resonance imaging (MRI), intraoperative fluoroscopy, and intraoperative CT (O-arm). Results were compared to literature-reported radiation doses.
Overall, 100 patients and 26 providers completed the survey. Only 31% of patients were informed about outpatient radiation exposure, and only 23% of those who had undergone spine surgery had been informed about intraoperative radiation exposure. For lumbar radiographs, patients and surgeons underestimated CXR-equivalent radiation exposures: AP by five-fold (P < 0.0001) and seven-fold (P < 0.0001), respectively, and lateral by three-fold (P < 0.0001) and four-fold (P = 0.0002), respectively. For cervical CT imaging, patients and surgeons underestimated radiation exposure by 18-fold (P < 0.0001) and two-fold (P = 0.0339), respectively. For lumbar CT imaging, patients and surgeons underestimated radiation exposure by 31-fold (P < 0.0001) and three-fold (P = 0.0001), respectively. For intraoperative specific cervical and lumbar imaging, patients underestimated radiation exposure for O-arm by 11-fold (P < 0.0001) and 22-fold (P = 0.0002), respectively. Surgeons underestimated radiation exposure of lumbar O-arm by three-fold (P = 0.0227).
This study evaluated patient and physician knowledge of radiation exposure related to spine procedures. Underestimation of radiation exposure in the outpatient setting was consistent with prior study findings. The significant underestimation of intraoperative cross-sectional imaging (O-arm) is notable and needs attention in the era of increased use of such technology for imaging, navigation, and robotic spine surgery.
横断面调查。
检查患者和医生对脊柱手术相关辐射暴露的估计。
患者在接受脊柱手术时通常会受到辐射。先前的研究表明，患者和医生对外科门诊环境中的辐射暴露知之甚少。这一点尚未针对术中成像进行评估。
开发了一份问卷，以评估在门诊和术中脊柱护理环境中对辐射暴露的认识/知识。患者和外科医生估计颈椎射线照相术（CXR）等效辐射来自：颈椎和腰椎射线照相术（前后位[AP]和侧位）、计算机断层扫描（CT）、磁共振成像（MRI）、术中透视和术中 CT（O 臂）。结果与文献报道的辐射剂量进行了比较。
共有 100 名患者和 26 名医生完成了调查。只有 31%的患者被告知门诊辐射暴露情况，只有 23%的接受过脊柱手术的患者被告知术中辐射暴露情况。对于腰椎射线照相术，患者和外科医生低估了 CXR 等效辐射暴露：AP 分别低估了五倍（P<0.0001）和七倍（P<0.0001），而 lateral 则分别低估了三倍（P<0.0001）和四倍（P=0.0002）。对于颈椎 CT 成像，患者和外科医生低估了 18 倍（P<0.0001）和两倍（P=0.0339）的辐射暴露。对于腰椎 CT 成像，患者和外科医生低估了 31 倍（P<0.0001）和三倍（P=0.0001）的辐射暴露。对于术中特定的颈椎和腰椎成像，患者低估了 O 臂的辐射暴露，分别为 11 倍（P<0.0001）和 22 倍（P=0.0002）。外科医生低估了腰椎 O 臂的辐射暴露，为三倍（P=0.0227）。
本研究评估了患者和医生对脊柱手术相关辐射暴露的知识。对外科门诊环境中辐射暴露的低估与先前的研究结果一致。术中横断面成像（O 臂）的显著低估值得注意，在日益使用这种技术进行成像、导航和机器人脊柱手术的时代，需要引起关注。
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