![]() However, radiation exposure from intraoperative imaging remains a significant concern for patients, surgeons, and other operative room personnel. Biplanar fluoroscopy was one of the first real-time intraoperative imaging modalities, and remains the dominant technique amongst orthopaedic and spinal practitioners. The use of intraoperative imaging is especially important in minimally-invasive procedures, where instrumentation is inserted percutaneously without the direct anatomic visualization afforded in open procedures. In order to ensure accurate placement of spinal instrumentation, intraoperative radiographic images are used to guide and confirm implant location. Specifically, injury to nearby neurovascular structures can occur, which often results in significant patient morbidity and financial burden on the healthcare system. ![]() Posterior pedicle screws are the most widely used instruments within spine surgery however, inaccurate positioning of such constructs can lead to significant intraoperative and postoperative adverse events. This is especially true in the field of spine surgery, where anterior and posterior instrumentation is frequently utilized to treat degenerative, traumatic, and neoplastic pathologies. The use of instrumentation and other implants is often necessary for orthopaedic surgical intervention. While this influx of new technology has advanced radiation safety within the field of spine surgery, more work is still required to overcome specific limitations involving increased costs and inadequate training. These modalities include Isocentric Three-Dimensional C-Arms, O-Arms, and intraoperative magnetic resonance imaging. New imaging modalities and spinal navigation systems have also been developed in an effort to replace conventional fluoroscopy and reduce radiation doses. Additionally, optimization of fluoroscopic settings and techniques can be used as an effective method of radiation dose reduction. All practitioners, regardless of practice setting, can practice radiation safety techniques including shielding and distance to reduce radiation exposure. In attempts to reduce radiation-associated health risks, radiation safety has become an important topic in the medical field. These effects often result in cell death or genomic instability, leading to various radiation-associated pathologies including an increased risk of malignancy. Radiation exposure in the form of ionizing radiation can lead to cellular damage via the induction of DNA lesions and the production of reactive oxygen species. However, the use of biplanar fluoroscopy and other intraoperative imaging modalities is associated with the risk of significant radiation exposure in the patient, surgeon, and surgical staff. Furthermore, an extensive literary review of similar dose recording studies suggest that a correlation is shared between head position and reducing effects of scattered radiation received by the eyes and thyroid based off of their proximity to the primary beam.Intraoperative imaging is vital for accurate placement of instrumentation in spine surgery. The findings of this research study potentially indicates that head position in relation to the primary beam may influence the amount of absorbed scatter radiation dose received by radiosensitive areas such as the eyes and thyroid region of a patient. The data collected was the result of multiple phantom experiments conducted in a radiography laboratory room of a Pacific Northwest mid sized university. Additionally, this data was compared with previously published literature, in order to establish whether or not the recorded doses are capable or otherwise significant in causing certain deterministic biological tissue effects. The focus of the study was to ascertain whether patient head position during such exams had a reducing effect on absorbed dose. The radiographic exams studied include the following exams: left posteroanterior (PA) hand, left anteroposterior (AP) elbow, and a right transaxillary shoulder projection. The importance of the research completed was to acquire knowledge in regard to secondary radiation doses received by the eyes of the patient and thyroid region during radiographic upper extremity exams.
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