Radiation exposure during the treatment of spinal deformities

Author:

Mehta Jwalant S.1,Hodgson Kirsten2ORCID,Yiping Lu3ORCID,Kho James Swee Beng4ORCID,Thimmaiah Ravindra1,Topiwala Upasana5ORCID,Sawlani Vijay2ORCID,Botchu Rajesh4ORCID

Affiliation:

1. Birmingham Spinal Unit, Royal Orthopaedic Hospital, Birmingham, UK

2. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

3. Department of Radiology, University of Birmingham, Birmingham, UK

4. Radiology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK

5. University of Birmingham College of Medical and Dental Sciences, Birmingham, UK

Abstract

Aims To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. Methods Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). Results There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. Conclusion The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-B(4):1–7.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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