167 Reducing Radiation an Order of Magnitude During Fluoroscopic-Guided Kyphoplasty

INTRODUCTION: Radiation exposure during x-ray intensive medical procedures is a potential health threat to physicians, staff, and patients alike. Simple steps, based around altering the dose settings and pulse rate on a conventional fluoroscope, can reduce radiation over 90% compared with conventional fluoroscopy, but these unfortunately affect image clarity, limiting their utility in clinical practice. METHODS: Physicians with experience performing kyphoplasty were asked to perform 2 kyphoplasties in cadaveric specimens at adjacent spinal levels. The physicians were blinded, randomly performing identical procedures with either conventional fluoroscopy or 1 pulse/low-dose imaging coupled with image enhancement. The number of images before cement injection and the amount of radiation in mGy for each procedure was recorded. RESULTS: Seven spine surgeons performed 14 kyphoplasties throughout the thoracolumbar spines of 2 human cadavers. Despite statistically similar number of images with both methods before cement injection (24 Conventional vs 21 Lessray Enhanced, P = .30), the pulsed/low-dosed procedures achieved an overall 88.8% radiation reduction over conventional imaging (36.1 mGy vs 4 mGy, P < .001). CONCLUSION: This study demonstrates that setting the c-arm to pulse and low-dose imaging significantly reduces the amount of radiation exposure during a radiation intensive medical procedure when compared with conventional fluoroscopy. By digitally improving low-radiation images, the procedure can progress without altering the steps or the number of images taken. This order of magnitude reduction in radiation can potentially help mitigate the health hazards associated with ionizing radiation.