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Intraoperative localization of the correct spine level can be challenging when dealing with the thoracic spine; especially in morbidly obese patients and in mid-thoracic spine lesions. Different radiological reference markers techniques for dorsal surgery have been reported without a clear DAP (effective dose), localization and surgical time analysis. The aim of the study is to analyze the radiological reference markers technique in terms of localization time and radiation dose during surgery for dorsal lesions. We used a radiopaque ma