Cervical spine imaging using mini--C-arm fluoroscopy: patient and surgeon exposure to direct and scatter radiation.

STUDY DESIGN: Direct and scatter radiation was measured during cadaveric cervical spine imaging with a mini-C-arm fluoroscope.

OBJECTIVE: The purpose of this study was to evaluate radiation exposure to the patient and surgeon when using a mini-C-arm fluoroscope to image the cervical spine.

SUMMARY OF BACKGROUND DATA: Prior studies have quantified radiation exposure using large C-arm fluoroscopy during procedures involving the cervical, thoracic, and lumbar spine. To our knowledge, no studies have quantified radiation exposure during mini-C-arm fluoroscopy of the cervical spine.

METHODS: A calibrated OEC MINI 6800 C-arm was used to image a prepared cadaveric cervical spine specimen, which included the skull. The specimen was suspended on an adjustable polycarbonate platform. Thirteen film badge dosimeters were mounted at various positions and angles to detect direct and scatter radiation. Recorded exposure levels were collected and analyzed.

RESULTS: Surgeon exposures from the mini-C-arm were considerably lower than previously reported with the standard C-arm, but nonetheless concerning. Patient exposures were considerable and not always reduced compared with values from the standard C-arm. The kVp generated by the mini-C-arm was similar to the standard C-arm. Dosimeters mounted in the same plane recorded dissimilar amounts of radiation during the same test, which underscores the influence of shape on the amount of reflected scatter.

CONCLUSIONS: Although using a mini-C-arm unit may reduce exposure levels, substantial exposure to both patient and staff is still achievable. Use of a mini-C-arm for cervical spine imaging reduces exposure to the surgeon more effectively than to the patient. To lower the risk of radiation exposure in the cadaver laboratory, a mini-C-arm should be used in each instance that offers appropriate visualization. In the operating room, all appropriate radiation dose-reducing measures should be strictly enforced by supervising physicians to minimize risk to patients, medical staff, and themselves.