Dose Reduction Protocol for Full Spine X-ray Examination Using Copper Filters in Patients With Adolescent Idiopathic Scoliosis

Minehiro, Kaori; Demura, Satoru; Ichikawa, Katsuhiro; Sasagawa, Takeshi; Takahashi, Naoki; Minami, Syuhei; Murakami, Hideki; Tsuchiya, Hiroyuki

doi:10.1097/brs.0000000000002787

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…The optimal radiation dose required for adequate image quality should be determined to reduce radiation exposure. Furthermore, full spine X-ray examinations using 0.2-mm Cu filters could reduce radiation exposure more than 60% while preserving the image quality [27]. New microdose X-ray machinery with or without reduced radiation protocols could reduce the amount of radiographic radiation doses [26,28,29].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population

Heijboer,

Heemskerk,

Vorrink

et al. 2024

JCM

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Background and Objectives: Epidemiological studies have demonstrated the potential oncogenic effects of cumulative radiation exposure, particularly during childhood. One group experiencing repeated exposure to radiation at an early age for multiple years is patients treated for idiopathic scoliosis (IS). This study aimed to determine the relationship between childhood radiological exposure and adult cancer prevalence in children treated for IS. Materials and Methods: Data from 337 predominantly female patients treated at our hospital between January 1981 and January 1995 were gathered and compared to the Dutch national cancer rates. The standardized prevalence ratios for cancer in IS patients were compared with the cancer prevalence rates from the general Dutch population. Results: The overall cancer prevalence in women was 5.0%, with no significant difference compared to the general population (p = 0.425). The results of this study do not suggest that female patients treated for idiopathic scoliosis during childhood have an increased risk of cancer later in life. Conclusion: Despite being the largest recent study in its field, the modest participant number limits its ability to draw conclusions. However, the detailed data collected over a long observation period, alongside data from a period with comparable radiation rates, contributes to refining clinical practice and laying the groundwork for future systematic reviews.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population

Heijboer,

Heemskerk,

Vorrink

et al. 2024

JCM

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“… 15 The entrance surface doses for non-filtered radiography of anteroposterior and lateral images of the whole spine are reported to be 0.31 and 0.93 mGy, respectively. 16 Radiation exposure for AIS patients may increase lifetime cancer risk. 17 However, not all spine surgeons are fully aware of the potential cancer risk in patients associated with radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Combination of Side-Bending and Traction Radiographs Do Not Influence Selection of Fusion Levels Compared to Either One Alone in Adolescent Idiopathic Scoliosis

Arima

Dimar

Glassman

et al. 2021

Global Spine Journal

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Study Design: A retrospective study. Objectives: Curve flexibility in patients with adolescent idiopathic scoliosis (AIS) can be evaluated using different techniques. This study aimed to determine whether the combination of side-bending (SB) and traction (TX) radiographs influences preoperative planning for AIS than either radiograph alone. Methods: Thirty-two spine surgeons were asked to review 30 AIS Lenke type 1 cases and select an upper instrumented vertebra (UIV) and lower instrumented vertebra (LIV) for the posterior spinal instrumentation of each case. Each rater reviewed the cases 3 times in each round. The raters were provided with the full-length posteroanterior (PA) and lateral standing and SB radiographs for round 1; PA, lateral, and TX radiographs for round 2; and PA, lateral, SB, and TX radiographs for round 3. Intra- and inter-rater reliabilities were evaluated using Kappa statistics. Results: The intra-rater reliability for UIV and LIV was 0.657 and 0.612 between rounds 1 and 2, 0.634 and 0.692 between rounds 1 and 3, and 0.659 and 0.638 between rounds 2 and 3, respectively, which indicated substantial agreement between rounds. The inter-rater kappa reliabilities for UIV and LIV selection were 0.103 and 0.412 for round 1, 0.121 and 0.380 for round 2, and 0.125 and 0.368 for round 3, indicating slight to moderate agreement between raters. Conclusions: Whether raters used either SB or TX radiography, or both in addition to PA and lateral standing radiographs, did not influence the decision making for UIV or LIV of AIS Lenke type 1 surgery.

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“…Conservative therapy with bracing and physiotherapy are common treatment options all over the world (2). AIS usually requires annual full spine radiography during conservative treatment, because the deformity can progress until skeletal maturity is reached (3). This monitoring leads to elevated radiation dose during childhood and especially during adolescence, when the bones are growing at an accelerated rate.…”

Section: Introductionmentioning

confidence: 99%

Is a further reduction of radiation exposure in scoliosis monitoring achievable using flat detector and pulsed fluoroscopy technology? - A feasibility study on human specimen

Walter

Schaefer

Tsiflikas

2020

Preprint

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Background: In the case of scoliosis therapy, frequent radiological monitoring of the spine is necessary. However, x-ray requires high radiation doses; therefore digital pulsed fluoroscopy with flat detector technique can be used alternatively. The latest developments in this technology lead to further dose reduction with an improved image quality. To evaluate the new system, we asked if there is a difference in dose area product (DAP) concerning the opening area (OA) and image quality settings (IQS). Further we wanted to investigate the inter-observer reliability using an established scoring system and correlate the DAP with the point value. Methods Therefore, we examined 4 cadaver spines (T1 to sacrum) with the flat detector technique using digital pulsed fluoroscopy and simulated the abdominal soft tissues with water bags. The images were merged calculating whole spine images from several digital single images and evaluated by 3 different investigators (spine surgeon, experienced pediatric radiologist, assistant physician) using an established scoring system. For comparison and validation of our model, we used digital radiography images of the cadaver spines. Results The values for the DAP increased from the small OA (33%; 0.56 µGy·m²) to the maximum OA (100%; 0.82 µGy·m²) by 45% (p = .003) and from low IQS (0.57 µGy·m²) to high IQS (0.84 µGy·m²) by 48% (p = .028). The inter-observer reliability was strong (3 vs. 1: ρ = .818; 3 vs. 2: ρ = .742; 2 vs. 1: ρ = .586; p <.001), but there was no correlation between DAP and point value (ρ = -.053, p = .588). Despite the low DAP, the setting 33% OA achieved the best point values, therefore this setting is preferred. Conclusions Using a digital fluoroscopy system allows a significant reduction of radiation exposure for whole spine images by a factor of 7.5 (3.88 µGy·m² to 0.5 µGy·m²) compared to slot-scanning x-ray (EOS).

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Dose Reduction Protocol for Full Spine X-ray Examination Using Copper Filters in Patients With Adolescent Idiopathic Scoliosis

Abstract: 4.

Cited by 8 publications

References 5 publications

The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population

The Prevalence of Cancer in Dutch Female Patients with Idiopathic Scoliosis Compared with the General Population

Combination of Side-Bending and Traction Radiographs Do Not Influence Selection of Fusion Levels Compared to Either One Alone in Adolescent Idiopathic Scoliosis

Is a further reduction of radiation exposure in scoliosis monitoring achievable using flat detector and pulsed fluoroscopy technology? - A feasibility study on human specimen

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