Correction to: Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose.

Unfortunately, the first author surname was incorrectly published as "Harrison Farber" instead of "Farber" in original publication.

Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose.

PURPOSE: Radiation exposure is a necessary component of minimally invasive spine procedures to augment limited visualization of anatomy. The surgeon's exposure to ionizing radiation is not easily recognizable without a digital dosimeter-something few surgeons have access to. The aim of this study was to identify an easy alternative method that uses the available radiation dose data from the C-arm to accurately predict physician exposure. METHODS: The senior surgeon wore a digital dosimeter during all minimally invasive spine fusion procedures performed over a 12-month period. Patient demographics, procedure information, and radiation exposure throughout the procedure were recorded. RESULTS: Fifty-five minimally invasive spine fusions utilizing 330 percutaneous screws were included. Average radiation dose was 0.46 Rad/screw to the patient. Average radiation exposure to the surgeon was 1.06 ± 0.71 µSv/screw, with a strong positive correlation (r = 0.77) to patient dose. The coefficient of determination (r2) was 0.5928, meaning almost two-thirds of the variability in radiation exposure to the surgeon is explained by radiation exposure to the patient. CONCLUSIONS: Intra-operative radiation exposure to the patient, which is easily identifiable as a continuously updated fluoroscopic monitor, is a reliable predictor of radiation exposure to the surgeon during percutaneous screw placement in minimally invasive spinal fusion surgery and therefore can provide an estimate of exposure without the use of a dosimeter. With this, a surgeon can better understand the magnitude of their exposure on a case-by-case basis rather than on a quarterly basis, or more likely, not at all. These slides can be retrieved under Electronic Supplementary Material.

C-arm Positioning Is a Significant Source of Radiation in Spine Surgery.

STUDY DESIGN: Prospective chart review. OBJECTIVE: It is well-known that radiation exposure during minimally invasive spine procedures can be substantial. Less interest has focused on setup radiation exposure before incision, including preoperative images used for surgical approach. The present study seeks to better quantify the significance of setup radiation in the total radiation exposure of minimally invasive spine surgery. SUMMARY OF BACKGROUND DATA: Radiographic localization is necessary in minimally invasive spine procedures to visualize anatomy, but increased radiation exposure is associated with health risks. Preoperative imaging for anatomical localization has not been previously analyzed as an appreciable source of radiation. METHODS: From an institutional review board-approved database of more than 1100 procedures, the minimally invasive spine cases with recorded set-up radiation were extracted. The total radiation, set-up radiation, and procedure type data were evaluated. Statistics were generated using a chi-squared analysis. RESULTS: Set-up and total radiation data were collected for 270 spine surgeries performed by four surgeons at two locations. There were 30 thoracic and 240 thoracolumbar/lumbar cases; 78 anterior and 192 posterior cases. Average total radiation (set-up and intraoperative) was 8.04 rad, and average setup radiation was 1.90 rad (28%, std 2.97 rad) across all cases. On average for the thoracolumbar/lumbar cases, set-up radiation accounted for almost 25% of total radiation with 1.76 rad from setup out of 8.16 rad total. Thoracic-only cases often necessitated even more images for localization, generating an average set-up/total percentage of 52%. Across all procedures, set-up radiation significantly increased the total radiation exposure because it accounted for more than 25% of the total procedure. CONCLUSION: Radiation exposure during preoperative localization can be substantial. Operating room personnel should recognize the high percentage of radiation that occurs during set-up, and merit should be given to techniques and technologies that can limit unnecessary radiation exposure during this portion of the procedure. LEVEL OF EVIDENCE: 2.