3D cone-beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography
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BASIC SCIENCE
3D cone‑beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography Vidyadhar V. Upasani1,2 · Harsha Bandaralage2 · Christine L. Farnsworth2 Received: 25 March 2020 / Accepted: 29 August 2020 © Scoliosis Research Society 2020
Abstract Study design Three imaging techniques were compared using porcine spines. Objectives To compare image acquisition time, radiation exposure, pedicle width measurement, assessment of screw breach, and image artifact between cone-beam tomosynthesis (CBT) single mode, CBT dual mode (stereotactic CBT), and computed tomography (CT) imaging with and without spinal implants. Summary of background data CT is the standard for axial imaging of orthopedic procedures. CBT technology is being developed, allowing real-time intraoperative imaging and 3D surgical guidance. CBT may deliver useful axial imaging quicker with less radiation than current technologies. Methods Six porcine spines were instrumented with bilateral pedicle screws at six levels connected with 5.5 mm rods. Dosimeters were attached to four surfaces of spines. CT, CBT single and CBT dual images were acquired pre-implant and post-implant. Image acquisition and 3D reconstruction times were recorded. Pedicle widths were measured before and after instrumentation. Screw medial breaches were graded (0: no breach, 1: 4 mm). Artifact and/or distortion of each image was ranked (0 = none, 1 = mild, 2 = moderate, 3 = large). Image acquisition and reconstruction times, radiation dose, pedicle width, screw breach and artifact were compared between techniques. Results Total image acquisition and reconstruction times of CBT was significantly less (single: 9.9 ± 0.2 s, p 0.4) was similar amongst all techniques. Breach assessment was not different between groups (p = 0.257). CBT images had consistently lower artifact grades than CT. Conclusions Although CBT axial image quality appeared subjectively inferior to CT, it enabled consistent assessment of pedicle width and screw breach, at half time and 10× lower radiation exposure. With continued refinements, CBT technology may allow for adequate intra-operative axial imaging using low radiation exposure. Keywords Intraoperative imaging · Cone-beam tomosynthesis imaging · 3D spine imaging
Introduction Currently, the gold standard to obtain axial imaging for bony procedures is computed tomography (CT). This involves a separate visit for the patient as it is not yet available in most
* Vidyadhar V. Upasani [email protected] 1
University of California San Diego, San Diego, CA, USA
Rady Children’s Hospital-San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123, USA
2
hospital operating rooms. Despite substantial improvement in recent years, CT gives a high radiation exposure that may be especially concerning in children [1–3]. Alternatively, there is an increase in the amount of fluoroscopic imaging used during spine deformity cases, and concern of radiation exposure to both the patient and the surgical staff in th
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