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Metaxas V, Efthymiou F, Dimitroukas C, Delis H, Gatzounis G, Zampakis P, Tzortzidis F, Papadakos D, Constantoyannis C, Panayiotakis G. Lumbar discectomy and fusion: Organs’ dose and effective dose estimation using Monte Carlo simulation. Appl Radiat Isot 2023; 196:110781. [PMID: 36996533 DOI: 10.1016/j.apradiso.2023.110781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/19/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
In this study, the effect of patient- and procedure-related parameters on organs' dose (OD), peak skin dose (PSD) and effective dose (ED) during lumbar discectomy and fusion (LDF) was assessed. Intra-operative parameters obtained from 102 LDFs were inserted into VirtualDose-IR software implementing sex-specific and BMI-adjustable anthropomorphic phantoms for dosimetric calculations. Fluoroscopy time (FT), kerma-area product (KAP), cumulative and incident air-kerma (Kair) were also recorded from the dosimetric report of the mobile C-arm. An increase in KAP, Kair, PSD and ED was found for male or higher BMI patients, multi-level or fusion or L5/S1 procedures. However, a significant difference was found only for PSD and incident Kair between normal and obese patients and for FT between discectomy and discectomy and fusion procedures. The spleen, kidneys and colon received the highest doses. The BMI have a significant impact only for kidneys, pancreas, and spleen doses when comparing obese to overweight and for urinary bladder when comparing overweight to normal patients. Multi-level and fusion procedures resulted in significantly higher doses for lungs, heart, stomach, adrenals, gallbladder and kidneys, while pancreas and spleen doses significantly increased only for multi-level procedures. Additionally, a significant increase was found only for urinary bladder, adrenals, kidneys, and spleen ODs when comparing L5/S1 and L3/L4 levels. The mean ODs were lower compared to the literature. These data may aid neurosurgeons in optimising exposure techniques during LDF to keep patients' dose as low as is practicably possible.
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Affiliation(s)
- Vasileios Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Fotios Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Christos Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece; Department of Medical Physics, University Hospital of Patras, 26504, Patras, Greece
| | - Harry Delis
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - George Gatzounis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece; Department of Neurosurgery, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, University Hospital of Patras, 26504, Patras, Greece; Department of Radiology, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Fotios Tzortzidis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece
| | - Dimitrios Papadakos
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece
| | - Constantine Constantoyannis
- Department of Neurosurgery, University Hospital of Patras, 26504, Patras, Greece; Department of Neurosurgery, School of Medicine, University of Patras, 26504, Patras, Greece
| | - George Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece; Department of Medical Physics, University Hospital of Patras, 26504, Patras, Greece.
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