Radiation reduction in computer-assisted spinal deformity surgery using 3D and 2D pediatric specific low-dose fluoroscopy protocols.

Background: Computer-assisted navigation (CAN) facilitates accurate pedicle screw insertion in the surgical correction of adolescent idiopathic scoliosis (AIS), but exposes patients to ionizing radiation via 3D cone-beam CT and 2D fluoroscopy. The aim of this study was to evaluate pediatric-specific low-dose 3D and 2D imaging protocols, assessing their effect on radiation reduction and imaging quality. Methods: Thirty AIS patients were prospectively enrolled: 10 in the standard 3D protocol and 20 in the low-dose 3D protocol. Standard- and low-dose 2D fluoroscopy was used throughout, independently from 3D dose. Outcome measures included intraoperative radiation dose expressed as dose-area product (DAP), objective image quality (signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)), and subjective image quality scoring. Results: The median 3D radiation dose was significantly lower for the low-dose protocol compared to the standard protocol (24.6 vs. 57.7 cGy*cm Conclusions: The low-dose 3D protocol achieved a radiation reduction of 57%. Despite minor, nonsignificant reductions in SNR and CNR, subjective image quality remained adequate. This supports clinical adoption of the low-dose 3D protocol, offering substantial radiation savings. 2D fluoroscopy also contributed substantially to total intraoperative dose. 2D dose may be reduced by intraoperative measures such as minimizing frame rate.