• Saurabh Kapoor, Kenneth O'Dowd, Aaron Hilis, and Nasir Quraishi.
• Department of Spinal Surgery, Queen's Medical Center, 15 Chester House, Nottingham, NG3 5AW, United Kingdom. docsaurabhkaps@gmail.com.
• Eur Spine J. 2021 Jul 1; 30 (7): 1920-1927.

BackgroundO-arm assisted pedicle screw placement has been proven to be more accurate than free-hand technique. Radiation exposure remains the primary drawback. We determined the feasibility and safety of a reduced radiation protocol in paediatric patients undergoing scoliosis correction.MethodsA reduced radiation protocol for a medtronic O-arm navigational system was devised. 3D CT reconstructions of an anthropomorphic pelvic phantom indicated adequate image quality after reduction to 14% of current manufacturer default factors. A feasibility study to test the image quality was undertaken on four patients, one with syndromic and three with idiopathic scoliosis each receiving progressively reducing radiation exposure of 60%, 50%, 40% and 14% of what would have been delivered using the manufacturer default protocol. This represented 32% of the mayo clinic protocol. It was achieved by reducing the x-ray tube current to 10 mA while keeping the tube potential at 90 kVp.ResultsA low dose O-arm protocol was able to generate adequate image quality while delivering as little as 14% (for lumbar region reconstructions) of the recommended protocol radiation dose. The total radiation dose delivered with this protocol was approximately 0.8 milliSieverts for a single spin. This effective dose represents < 1/3 of average UK and < 1/6 average US annual radiation exposure. There were no neurological or implant-related complications.ConclusionsOur low dose O-arm radiation protocol significantly reduces the radiation exposure compared to the manufacturer recommended Mayo clinic protocol providing operational image quality to allow accurate screw placement in spinal deformity.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

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