Estimation of organ and effective dose to the patient during spinal surgery with a cone-beam O-arm system

The purpose of this study was to estimate organ and effective dose to the patient during spinal surgery with a cone-beam O-arm system. The absorbed dose to radiosensitive organs and effective dose were calculated on mathematically simulated phantom corresponding to a 15-year-old patient using PCXMC 2.0. Radiation doses were calculated at every 15 degrees of the x-ray tube projection angle at two regions: thoracic spine and lumbar spine. Two different scan settings were investigated: 120 kV/128 mAs (standard) and 80 kV/80 mAs (low-dose). The effect on effective dose by changing the number of simulated projection angles (24, 12 and 4) was investigated. Estimated effective dose with PCXMC was compared with calculated effective dose using conversion factors between dose length product (DLP) and effective dose. The highest absorbed doses were received by the breast, lungs (thoracic spine) and stomach (lumbar spine). The effective doses using standard settings were 5 times higher than those delivered with low-dose settings (2-3 scans: 7.9-12 mSv versus 1.5-2.4 mSv). There was no difference in estimated effective dose using 24 or 12 projection angles. Using 4 projection angles at every 90 degrees was not enough to accurate simulate the x-ray tube rotating around the patient. Conversion factors between DLP and effective dose were determined. Our conclusion is that the O-arm has the potential to deliver high radiation doses and consequently there is a strong need to optimize the clinical scan protocols.