Approaches to Dose Reduction in Surgery

Dose Reduction Advances in Surgery
In today’s clinical environment, surgery would be unimaginable without X-ray. Surgical C-arms help to give insight into the human body before, during and after surgical intervention. For example, a surgeon is able to check screw placement in a complicated fracture using 2D and even 3D images during the intervention. This helps to increase safety and accuracy of the intervention and also prevents additional postoperative X-ray follow-up; thus avoiding unnecessary radiation for patients and clinical staff. 

Nonetheless, every radiographic exam, however necessary it might be, means exposure to X-ray for the patient as well as for the staff. That’s why Siemens strives to combine the best possible image quality with the lowest possible dose for all C-arm systems.  

Direct and Indirect Dose Savings

Dose-saving techniques can be embedded within the system itself and also enabled through easier workflows or new technologies that help to reduce radiation dose exposure throughout the entire procedure.
With ARCADIS Orbic 3D, Siemens introduced the first truly isocentric mobile C-arm with the capability to provide intraoperative 3D images. ARCADIS Orbic 3D incorporates all available dose-saving features. Its true isocentricity provides the advantage of always maintaining the central beam in the isocenter, nearly eliminating the need for repositioning. In addition to time savings, this means considerable savings in dose.
In addition, every ARCADIS system comes equipped with EASY (Enhanced Acquisition System), a bundle of automatic image processing features that allow ARCADIS systems to automatically analyze the images during acquisition and optimize brightness, contrast and dose. 

Furthermore, ARCADIS Orbic 3D features NaviLink 3D, an integrated navigation interface with automatic image transfer. The open interface allows computer-assisted surgery systems to be connected to C-arms, permitting radiation-free navigated interventions. Thus, the surgeon is able to reduce indirectly the radiation measured for the entire intervention.
Dedicated CARE* features may also be allocated to other surgical C-arms. 

CARE features include:

1. Radiation-free positioning of primary collimators through graphical display on the image monitor
2. Laser light localizers for positioning without dose application
3. 3D features to minimize postoperative imaging
4. Interface for remote surgical navigation systems
5. Pulsed fluoroscopy for minimal dose application
6. Detachable grid for further dose reduction
7. Copper filters 

In addition to these individual features, Siemens provides comprehensive dose monitoring and reporting for every intervention. Elements such as visualizing the air kerma rate on the display and providing a defined threshold with warning messages when a certain limit of dose application is reached assists physicians and staff in limiting X-ray exposure.
 

*CARE: Combined Applications to Reduce Exposure (CARE), a Siemens initiative for dose reduction.