- Department of Biology, Stony Brook University, Stony Brook,
- Department of Neurosurgery and
- Department of Orthopedic Surgery, Brain and Spine Surgeons of New York, West Harrison, New York, United States.
Department of Orthopedic Surgery, Brain and Spine Surgeons of New York, West Harrison, New York, United States.
DOI:10.25259/SNI_289_2020Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Anirudh Murthy1, Ezriel Kornel2, Seth Neubardt3. Strategy to reduce radiation exposure in postoperative spinal computed tomography scans. 14-Apr-2021;12:159
How to cite this URL: Anirudh Murthy1, Ezriel Kornel2, Seth Neubardt3. Strategy to reduce radiation exposure in postoperative spinal computed tomography scans. 14-Apr-2021;12:159. Available from: https://surgicalneurologyint.com/surgicalint-articles/10713/
Background: When diagnosing and treating spinal disorders, spine surgeons commonly utilize computed tomography (CT) scans preoperatively, intraoperatively, and postoperatively.
Methods: This article reviews the literature regarding the potentially harmful effects of X-rays, specifically from CT scans.
Results: The risk for damaging DNA and developing cancer increases with increasing scan length (e.g., increasing amount of radiation received).
Conclusion: When assessing postoperative status, CT scans should be directed only through the area of specific interest to limit the total dose of radiation received by the patient.
Keywords: Cancer, Computed tomography, Computed tomography scans, Radiation, Spinal surgery, Spine
Due to its utility in medicine, the incidence of computed tomography (CT) examinations has exponentially increased in the past few decades. There were an estimated 80 million scans performed in 2019, 5–9 million of which were performed in pediatric patients; this constitutes an annual growth rate of about 10%.[
Mechanism of action
Multiple studies have explored the effect of ionizing X-rays from CT scans.[
The effective radiation dose resulting from a single spinal CT scan ranges from 1.5 mSv to 10 mSv.[
The risks associated with radiation are cumulative.[
Assuming the lifetime risk of developing cancer in America is 20%, the risk from CT scans seems relatively benign.[
The Yale School of Medicine identified multiple factors that directly impact patient exposure including detector configuration, tube current, reconstruction algorithm, patient positioning, and scan range.[
Here, we propose applying a “limited field exposure” focusing on the area of surgery in postoperative spinal CT scans. Standard protocols for postoperative CT scans image the entire section of the spine (i.e., cervical, thoracic, lumbar, or sacral spine) for which the procedure was performed. However, the region of interest with respect to postoperative evaluations is usually limited to the specific vertebrae impacted by surgery. For two-level lumbar spinal surgery, the CT scan should be limited to the two lumbar vertebrae alone; by not including L1-S1, this would reduce the total radiation exposure by 66%. As the cervical spinal contains a greater number of spinal levels, radiation reduction here could theoretically be as high as 75%.
To reduce the risks associated with excess radiation exposure, we should adopt a postoperative CT protocol focusing only on the operated spinal levels.
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