Van Ngoc Ty Claire, Fitton Isabelle, Arvieu Robin, Ferrero Emmanuelle, Garreau de Loubresse Christian, Khalifé Marc
Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France.
Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France.
Eur Spine J. 2024 May;33(5):2043-2048. doi: 10.1007/s00586-024-08236-3. Epub 2024 Apr 2.
Intraoperative fluoroscopy use is essential during spinal fusion procedures. The amount of radiation dose should always be minimized. This study aimed to determine the feasibility of halving the frame rate from 12.5 to 6.25 frames per second (fps) and to quantify the reduction in the risk of developing radiation-induced cancer.
This pilot study included 34 consecutive patients operated for open lumbar posterolateral fusion (PLF) with or without transforaminal lumbar interbody fusion (TLIF). C-arm modes were changed from half-dose (12.5 frames per second (fps), group I) to quarter-dose (6.25 fps, group II). Age, body mass index, surgical procedure, number of treated levels, and complications were collected. Kerma area product (KAP), cumulative air kerma (CAK), and fluoroscopy time were compared. Effective dose and radiation-induced cancer risk were estimated.
Eighteen and 16 patients were, respectively, included in group I and II. Demographic, surgical data, and fluoroscopy time were similar in both groups. However, CAK, KAP, and effective dose were significantly lower in group II, respectively, 0.56 versus 0.41 mGy (p = 0.03), 0.09 versus 0.06 Gy cm (p = 0.04), and 0.03 versus 0.02 mSv (p = 0.04). Radiation-induced cancer risk decreased by 47.7% from 1.49 × 10 to 7.77 × 10 after optimization. No complications were recorded in either group.
This study demonstrates the feasibility of setting 6.25 fps for TLIF with and without PLF. By halving the fps, radiation-induced cancer risk could be almost divided by two, without compromising surgical outcome. Finally, after optimization, the risk of developing radiation-induced cancer was less than one in a million.
在脊柱融合手术中，术中使用荧光透视至关重要。辐射剂量应始终保持最小化。本研究旨在确定将帧率从每秒12.5帧降至每秒6.25帧的可行性，并量化辐射诱发癌症风险的降低程度。
这项前瞻性研究纳入了34例连续接受开放性腰椎后外侧融合术（PLF），伴或不伴经椎间孔腰椎椎体间融合术（TLIF）的患者。C形臂模式从半剂量模式（每秒12.5帧，第一组）改为四分之一剂量模式（每秒6.25帧，第二组）。收集患者的年龄、体重指数、手术方式、治疗节段数量及并发症情况。比较比释动能面积乘积（KAP）、累积空气比释动能（CAK）和透视时间。估算有效剂量和辐射诱发癌症的风险。
第一组和第二组分别纳入了18例和16例患者。两组的人口统计学、手术数据和透视时间相似。然而，第二组的CAK、KAP和有效剂量显著更低，分别为0.56 mGy对0.41 mGy（p = 0.03）、0.09 Gy·cm对0.06 Gy·cm（p = 0.04）、0.03 mSv对0.02 mSv（p = 0.04）。优化后，辐射诱发癌症的风险从1.49×10降至7.77×10，降低了47.7%。两组均未记录到并发症。
本研究证明了在有或无PLF的TLIF中设置每秒6.25帧的可行性。通过将帧率减半，辐射诱发癌症的风险几乎可减半，且不影响手术结果。最后，优化后，辐射诱发癌症的风险低于百万分之一。
