Radiation safety is an ever present concern in the field of orthopaedics. Spine surgeons, in particular, have a vested interest in the safe and appropriate use of radiation due to the nature of their practice [
1]. Improvements in spine stabilization systems, increased use of pedicle screws and advances in imaging technology have driven a renewed interest in evaluating the manner in which we approach the issue of radiation safety [
2‐
5]. There are several factors to consider when evaluating an imaging method to be used in the clinical setting. The primary area of concern is that of the wellbeing of the patient. As we endeavor to improve the clinical outcomes, we simultaneously must provide care in a safe, cost efficient manner. Radiation doses also have to be evaluated in the context of lifetime risk to the pediatric population [
6,
7]. A second consideration is the safety of the provider [
8]. Spine surgeons may have an awareness of the radiation risks of their profession, but the amount of exposure, cumulative exposure and long term effects are often underappreciated [
5,
9]. New advances in imaging technologies have brought additional variables to bear on the question of patient and provider safety [
10]. Several studies in the past 5 years have compared intraoperative navigation techniques with traditional techniques in terms of effective dose, but there are a limited number of studies that directly compare a surgeon using the O-arm exclusively with a surgeon who primarily uses a C-arm [
2,
11]. In general the current literature suggests that CT guided pedicle screw placement results in higher doses of radiation for the patient and lower doses for providers [
1,
8,
10‐
14]. Our purposed study focused on evaluating two of the most common radiographic techniques for pedicle screw placement in scoliosis surgery, the traditional fluoroscope and Medtronic O-Arm (Medtronic,™, 710 Medtronic Parkway Minneapolis, Minnesota, 55,432–5604). We evaluated these methods that were part of a standard practice to answer one basic question: Is there a measurable effective dose difference between the two methods for pedicle screw placement in pediatric scoliosis surgery? In addition to this basic question which has been addressed to some degree in the current literature, we sought to take into consideration the severity of the corrected curvature of the spine as an additional variable. Our study took calculated effective doses from both methods at the time of surgery and subsequently compared the doses to each other rather than to a historical value. Our hypothesis, therefore, was that there was a significant detectable difference between the two methods with respect to radiation dose. Statistical analysis also was utilized to compare effective doses along a continuum that took Cobb angle into consideration. While this information will not answer all questions regarding outcomes of surgery, accuracy of screw placement, long term results of radiation exposure, or provider biases due to training or experience, it can provide a foundational perspective upon which future research can be based and an additional point of discussion regarding safety that can be added to the conversation with patients regarding the chosen method.