• Norah Foster, Christopher Shaffrey, Avery Buchholz, Raymond Turner, Lexie Zidanyue Yang, Donna Niedzwiecki, and Allen Goode.
• Department of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: snorahppp@gmail.com.
• World Neurosurg. 2022 Apr 1; 160: e142e151e142-e151.

ObjectiveTo evaluate radiation exposure and image quality (IQ) for 3 intraoperative imaging systems (Airo TruCT, Cios Spin, O-arm) using varying radiation dose settings in a single cadaveric model.MethodsAxial images of L4-5 instrumentation were obtained using 3 manufacturer dose protocols for each system. Measurements included scattered radiation dose, subjective and objective IQ, and estimates of patient effective dose (ED). Four images per system were selected at each dose level. Using the Likert scale (1 = best, 5 = worst), 9 reviewers rated the same 36 images. Objective IQ measures included the degree of streak artifacts (lines with incorrect data from metal objects) in each image. A composite figure of merit was derived based on ED and subjective and objective scores.ResultsThe best subjective IQ scores were 1.44 (Cios Spin medium dose), 1.78 (Cios Spin high dose) and 2.22 (Airo TruCT low dose). The best objective IQ scores were 87.3 (Airo TruCT) and 89.1 (Cios Spin). ED low-dose results in mSv included 1.6 (Airo TruCT), 1.9 (Cios Spin), and 3.3 (O-arm). ED high-dose results in mSv included 4.6 (Cios Spin), 9.7 (Airo TruCT), and 9.9 (O-arm). Scatter radiation measurements for low dose in μGy included 21.9 (Cios Spin), 31.8 (Airo TruCT), and 33.9 (O-arm). Scatter radiation for high dose in μGy included 55.9 (Cios Spin), 104.5 (O-arm), and 200 (Airo TruCT). The best figure of merit score was for the Airo TruCT low dose, followed by Cios Spin medium dose and high dose.ConclusionsSelection of intraoperative imaging systems requires a greater understanding of the risks and benefits of radiation exposure and IQ.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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