General Session: Value and Outcomes in Spine Surgery

Presented by: K. Singh - View Audio/Video Presentation (Members Only)

Author(s):

D. Bohl(1), F. Hijji(1), A. Narain(1), D. Massel(1), B. Mayo(1), K. Kudaravalli(1), K. Yom(1), B. Manning(1), P. Louie(1), J. Ahn(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Spine surgeons employ a high volume of imaging in the diagnosis and monitoring of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques. The purpose of the present study is to characterize patients' knowledge regarding radiation exposure associated with common methods for imaging the cervical and lumbar spine.

Methods: An electronic survey was administered to all new patients prior to their first appointment with a single spinal surgeon. The survey asked patients to estimate how many chest x-rays (CXRs) worth of radiation were equivalent to various common spinal imaging modalities. Patient estimates were compared to the number of chest x-ray equivalents determined from published effective radiation doses. The survey also asked patients whether they would consider avoiding types of imaging out of concern for excessive radiation exposure.

Results: A total of 492 patients were invited to participate, of whom 100 patients (20.3%) fully completed the survey. Patients accurately approximated the radiation associated with two views of the cervical spine, with a median estimate of 3.5 CXRs, compared to an actual value of 4.7 CXRs (Figure 1). However, patients underestimated the dose for CT scans of the cervical spine (2.0 CXRs versus 145.3 CXRs; Figure 1), two views of the lumbar spine (3.0 CXRs versus 123.3 CXRs; Figure 2), and CT scans of the lumbar spine (2.0 CXRs versus 638.3 CXRs; Figure 2). The majority of patients believed there is radiation exposure associated with MRIs of both the cervical spine (Figure 1) and lumbar spine (Figure 2). The percent of patients who would consider forgoing imaging recommend by their surgeon out of concern for radiation exposure was 14% for x-rays, 13% for CT scans, and 9% for MRIs.

Conclusions: The results of this study demonstrate a lack of patient understanding regarding radiation exposure associated with common spinal imaging techniques. In particular, patients grossly underestimated the effective radiation dose associated with plain films of the lumbar spine and CT scans of both the lumbar and cervical spine. Moreover, the majority of patients incorrectly believed that MRIs expose them to radiation. These data suggest that patients might benefit from increased counseling and/or educational materials regarding radiation exposure prior to undergoing diagnostic imaging of the cervical or lumbar spine.

Figure 1

Figure 2