Are Radiographers and Other Professionals Safe When Operating an O-arm Imaging System in a Surgical Room?

Introduction

O-arm imaging system produces high-quality images, is reliable, and is easy to handle. These qualities have enabled O-arm to be the preferred choice for radiographers and surgeons. It is used in orthopedic, spine, and cranial-related surgeries. This surgical imaging platform provides real-time imaging in both 2D and 3D. However, it is prudent to note that O-arm exposes both radiographers and patients to radiations. This threatens their lives as radiations expose them to cancer and other forms of health complications. This paper critically examines existing literature that pinpoints that O-arm systems expose radiographers to radiation emissions.

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Keywords: O-arm imaging system, real-time imaging, radiographers, radiations

Are Radiographers and Other Professionals Safe When Operating an O-arm Imaging System in a Surgical Room?

Over the years, there have been technological advances aimed at increasing quality of scans obtained in a radiology. Many imaging systems have been developed such as X-Ray imaging system, C-arm technique, and O-arm imaging system among others. Each technology has advantages as well as disadvantages which makes each technique unique. The O-arm imaging system is a portable device and has a C-shaped arm fitting over a surgical table. Even though this imaging system has superior qualities over other methods, it exposes both patients and radiographers to a considerable amount of radiation.

Review of Literature

Several research studies have been done to assess the safety of the O-arm system on radiographers and other surgical staff. Nelson et al. (2014) conducted research to determine the level of exposure to radiation from surgical imaging systems during spinal surgery. The researchers made comparisons based on C-arm fluoroscopy, XR radiography, and O-arm imaging system. In this study, the researchers created plastic phantom that emulated patient volume as well as characteristics of the absorption scattering of adult abdominal volume. Ion chamber dosimeters were then used to measure radiation exposure by determining scatter exposures and entrance phantom at various positions of the surgical room staff for XR, O-arm, and C-arm imaging system. The results indicated that each imaging system had different levels of scatter radiation. The surface exposure LAT/AP for O-arm was 38/41 while it was 1.5/2.4 for XR exposures. Single exposures for C-arm method, XR radiography, and O-arm technique were 116/102mR, 3,435/2,160mR, and 4,360/5220mR respectively. The findings further revealed that the level of anesthesiologist scatter radiation was peak for O-arm system, XR radiology, and C-arm in that order for a unit acquisition. However, the researchers noted that when a unitary acquirement was used in all modalities, the overall exposure level was low (less than 4.4mR).

Another study by Park et al. (2011) sought to compare the level of exposure to radiation emissions by O-arm surgical imaging and C-arm systems. The researchers used 2D fluoroscopy modes to simulate an orthopedic operation procedure and radiation exposure to operators investigated. The findings revealed that radiographers who operated O-arm had considerable radiation amount as compared to those that operated C-arm. On the other hand, Nottmeier et al. (2013) compared radiation exposures at various positions around the O-arm imaging device. It was established that radiation exposure was high near the badge that was attached to the operating table. However, there was no exposure when radiographer stood behind the lead shield. Costa et al. (2016) suggest that radiographers and other OT specialist should protect themselves from radiations that O-arm emits as shown below.

The radiographer taking measurement at the top left of figure 1 receives protection from a lead shield located 2.5m from O-arm. Other radiographers and nurses protect themselves from radiation emissions behind a lead shield door about 2.5m from the machine. The red lines in figure 1 show areas in the OT that receive radiation emission. The intensity of radiation follows the inverse square law, which implies that radiation is highest near the source and decreases as the distance increases. Therefore, the area labeled 1 receives the highest amount of radiation followed by 2 and 3 in that order.

In a related study, Schils, Schoojans, and Struelens (2013) examined the effectiveness of cement delivery systems over conventional methods of performing radiology. A sample size of 20 patients took part in the study and the effect of radiation measured on radiographers' legs, wrists, and fingers using the two case study methods. The researchers noted that the O-arm technique exposed radiographer to radiation emissions as compared to when the cement delivery approach was used as there was more than 80% reduction of radiation exposures noted. In a similar research, Maruo and Maruo (2016) investigated the radiation exposure amount in O-arm technique as well as C-arm imaging in balloon kyphoplasty (BKP). The findings elucidated that O-arm had a greater radiation exposure amount of 35.994mGry as compared to C-arm that had a radiation exposure amount of 17.284mGry. In terms of exposure time, the findings revealed that using the O-arm method had shorter radiation time as compared to the C-arm system (35.227 vs. 94.886 seconds).

In their scholarly study, Mendelsohn et al. (2015) compared radiation emitted to patients and radiographers using O-arm. The researchers noted that patients were exposed more to radiation emissions from O-arm machines than radiographers. The researchers further compared surgeon radiation exposure when other methods such as fluoroscopic-guidance radiation. It was noted that though O-arm presented low radiographer exposure levels, there was an urgent need to safeguard radiographers from too much exposure to O-arm emissions. In another research study, Nancy (2014) compared the risks versus benefits associated with O-arm imaging machine utilization during spinal surgery. The researcher noted that out of 290 operations, 280 had pedicle screws successfully paced which accounted for 96.6% of sampled operations. It was generally noted that the O-arm system produced accurate and precise results when used in surgical procedures. Zhang and Zhang (2013) confirm this by explaining that o-arm has desirable physical characteristics that make it have an edge over traditional methods as shown in figure 2 below.

On the contrary, the researchers acknowledged the fact that O-arm exposed both patients and radiographers to radiation emissions which is detrimental to their health. In fact, Heidbuchel et al. (2014) revealed that the scatter radiations from patients are the chief source of radiographers' radiation exposure. This explains why female radiographers avoid taking images using O-arm.

Conclusion

Generally, O-arm imaging technology has gained prominence due to its ability to produce a more accurate and precise image as compared to other imaging systems. Despite the advantages exhibited by the O-arm system, this imaging machine exposes radiographers and surgeons to doses of radiation which is detrimental to their health. Therefore, it is imperative to develop measures that will minimize the risk of radiation exposure. One of the most effective ways is for radiographers to stand near lead shield when performing radiography. Also, radiographers need to maximize the distance them and patient surface because radiation intensity uses the inverse square law. Another way is to reduce fluoroscopic dose through the use of pulsed or low mode fluoroscopy.

References

1. Costa, F., Tosi, G., Attuati, L., Cardia, A., Ortolina, A., Grimaldi, M., ... & Fornari, M. (2016). Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases. Journal of Neurosurgery: Spine, 25(5), 654-659.

2. Heidbuchel, H., Wittkampf, F. H., Vano, E., Ernst, S., Schilling, R., Picano, E., ... & Piorkowski, C. (2014). Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace, 16(7), 946-964.

3. Maruo, Y., & Maruo, Y. (2016). The Comparison between O-Arm Navigation System and C-Arm Fluoroscopy Navigation System for the Amount of Radiation Exposure in Balloon Kyphoplasty. Global Spine Journal, 6(1), s-0036-158.

4. Mendelsohn, D., Strelzow, J., Batke, J., Dvorak, M., Fisher, C., Street, J., & Dea, N. (2015). Patient and Surgeon Exposure to Radiation in Intraoperative CT-Based Spine Navigation. Global Spine Journal, 5(1), s-0035-155.

5. Nancy E, E. (2014). Commentary: Utility of the O-Arm in spinal surgery. Surgical Neurology International, 5(16), Pp.517-519.

6. Nelson, E. M., Monazzam, S. M., Kim, K. D., Seibert, J. A., & Klineberg, E. O. (2014). Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery. The Spine Journal, 14(12), 2985-2991.

7. Nottmeier, E. W., Pirris, S. M., Edwards, S., Kimes, S., Bowman, C., & Nelson, K. L. (2013). Operating room radiation exposure in cone beam computed tomography-based, image-guided spinal surgery. Journal of Neurosurgery: Spine, 19(2), 226-231.

8. Park, M. S., Lee, K. M., Lee, B., Min, E., Kim, Y., Jeon, S., ... & Lee, K. (2011). Comparison of operator radiation exposure between C-arm and O-arm fluoroscopy for orthopedic surgery. Radiation Protection Dosimetry, 148(4), 431-438.

9. Schils, F., Schoojans, W., & Struelens, L. (2013). The surgeon's real dose exposure during balloon kyphoplasty procedure and evaluation of the cement delivery system: a prospective study. European Spine Journal, 22(8), 1758-1764.

10. Zhang, J., & Zhang, D. (2013). Image performance evaluation of a cone beam O-arm imaging system. Journal of X-Ray Science & Technology, 21(3), 373-380.