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3D cone-beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography

  • Basic Science
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Abstract

Study design

Three imaging techniques were compared using porcine spines.

Objectives

To compare image acquisition time, radiation exposure, pedicle width measurement, assessment of screw breach, and image artifact between cone-beam tomosynthesis (CBT) single mode, CBT dual mode (stereotactic CBT), and computed tomography (CT) imaging with and without spinal implants.

Summary of background data

CT is the standard for axial imaging of orthopedic procedures. CBT technology is being developed, allowing real-time intraoperative imaging and 3D surgical guidance. CBT may deliver useful axial imaging quicker with less radiation than current technologies.

Methods

Six porcine spines were instrumented with bilateral pedicle screws at six levels connected with 5.5 mm rods. Dosimeters were attached to four surfaces of spines. CT, CBT single and CBT dual images were acquired pre-implant and post-implant. Image acquisition and 3D reconstruction times were recorded. Pedicle widths were measured before and after instrumentation. Screw medial breaches were graded (0: no breach, 1: < 2 mm, 2: 2–4 mm, 3: > 4 mm). Artifact and/or distortion of each image was ranked (0 = none, 1 = mild, 2 = moderate, 3 = large). Image acquisition and reconstruction times, radiation dose, pedicle width, screw breach and artifact were compared between techniques.

Results

Total image acquisition and reconstruction times of CBT was significantly less (single: 9.9 ± 0.2 s, p < 0.001; dual: 60.0 ± 8.7 s, p < 0.001) than CT (250.3 ± 36.7 s). CBT had significantly less radiation exposure than CT (CT: 0.7 ± 0.1 rad, single: 0.03 ± 0.02 rad, dual: 0.07 ± 0.03 rad; p < 0.001). No difference in pedicle width change pre-implant to post-implant was found (CT: p = 0.449, single: p = 0.430, dual: p = 0.528). Pedicle width (pre-implant: p > 0.5, post-implant: p > 0.9) and pedicle width change (p > 0.4) was similar amongst all techniques. Breach assessment was not different between groups (p = 0.257). CBT images had consistently lower artifact grades than CT.

Conclusions

Although CBT axial image quality appeared subjectively inferior to CT, it enabled consistent assessment of pedicle width and screw breach, at half time and 10× lower radiation exposure. With continued refinements, CBT technology may allow for adequate intra-operative axial imaging using low radiation exposure.

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Acknowledgements

Tracey P. Bastrom, MS for statistical analysis.

Funding

nView medical (Salt Lake City, UT) funded the study in part and provided use of imaging equipment, software and radiolucent table. Additional support was from the Orthopedic Division, Children’s Specialists of San Diego. Grant of use of spinal implants and instrumentation from OrthoPediatrics, Warsaw, IN.

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Authors and Affiliations

  1. University of California San Diego, San Diego, CA, USA

    Vidyadhar V. Upasani

  2. Rady Children’s Hospital-San Diego, 3020 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Vidyadhar V. Upasani, Harsha Bandaralage & Christine L. Farnsworth

Authors
  1. Vidyadhar V. Upasani
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  2. Harsha Bandaralage
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  3. Christine L. Farnsworth
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Contributions

VU, CF—Design; Data acquisition, analysis and/or interpretation of work; Manuscript drafting and/or critically revising. Final approval of submitted manuscript. HB—Data acquisition, analysis and/or interpretation of work; Manuscript drafting and/or critically revising. Final approval of submitted manuscript.

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Correspondence to Vidyadhar V. Upasani.

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Upasani, V.V., Bandaralage, H. & Farnsworth, C.L. 3D cone-beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography. Spine Deform 9, 41–49 (2021). https://doi.org/10.1007/s43390-020-00199-x

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  • DOI: https://doi.org/10.1007/s43390-020-00199-x

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