Patient Size Indices and Dose in Fluoroscopically Guided Lumbar Discectomy and Fusion: A Preliminary Study.

Patient dose values varied significantly during interventional procedures, mainly due to the patient size, operators' choices and clinical complexity. In this study, the effect of applying a previously described and validated size-correction method to normalise kerma-area product (KAP) and average KAP rate values of the whole procedure (KAP rate) and isolate variations in dose due to the patient size and complexity, during lumbar discectomy and fusion (LDF) procedures, was investigated. Fluoroscopy time (FT), KAP, KAP rate and patient size data (weight, height and equivalent diameter) were recorded, for 96 patients who underwent single or multilevel LDF procedures by three senior neurosurgeons, defining three different patient groups (surgeon 1, surgeon 2, surgeon 3). Simple linear regression and coefficients of determination were used to investigate the relationship between uncorrected and corrected KAP and KAP rate values and patient size indices in these groups. The results showed that the size correction decreased the influence of patient size and could contribute to the isolation of the variations in patient dose due to the patient size. From this point of view, dose surveys during lumbar spine interventions may include dosimetric data from all patients independently of their body size and not only for standard-sized patients, providing the advantage of accessible data collection for the establishment of local dose reference levels and optimisation purposes, within the framework of the radiation protection program in the Neurosurgery Department.