Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice

Alshamari, Muhammed; Geijer, Mats; Norrman, Eva; Lidén, Mats; Krauß, W.; Wilamowski, Franciszek; Geijer, Håkan

doi:10.1177/0284185115595667

Cited by 27 publications

(26 citation statements)

References 23 publications

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“…However, this direct comparison has already been performed by Alshamari, demonstrating the diagnostic superiority of CT. Furthermore, our study reported similar dose levels to plain radiographs, as previously described [ 1 , 18 ].…”

Section: Discussionsupporting

confidence: 87%

Highly reduced-dose CT of the lumbar spine in a human cadaver model

et al. 2020

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Purpose Feasibility of a highly reduced-dose lumbar spine CT protocol using iterative reconstruction (IR) in a human cadaver model. Materials and methods The lumbar spine of 20 human cadavers was repeatedly examined using three different reduced-dose protocols (RDCT) with decreasing reference tube current-exposure time products (RDCT-1: 50 mAs; RDCT-2: 30 mAs; RDCT-3: 10 mAs) at a constant tube voltage of 140 kV. A clinical standard-dose protocol (SDCT) served as the reference (reference tube current–exposure time product: 70 mAs; tube voltage: 140 kV). Images were reconstructed using filtered back projection (FBP) and two increasing levels of IR: IRL4 and IRL6. A five-point scale was used by two observers to assess the diagnostic quality of anatomical structures (cortical and trabecular bone, intervertebral foramina, pedicles and intervertebral joints, spinous and transverse processes). Objective image noise (OIN) was measured. Results were interpreted using a linear mixed-effects regression model. Results RDCT-2 with IRL6 (1.2 ± 0.5mSv) was the lowest reduced-dose protocol which provided diagnostically acceptable and equivalent image quality compared to the SDCT (2.3 ± 1.1mSV) with FBP (p > 0.05). All RDCT protocols achieved a significant reduction of the mean (±SD) effective radiation doses (RDCT-1: 1.7±0.9mSv; RDCT-2: 1.2±0.5mSv; RDCT-3: 0.4±0.2mSv; p < 0.05) compared to SDCT. OIN was lower in all RDCT protocols with the application of IRL4 and IRL6, compared to the SDCT with FBP (p < 0.05). Conclusion Highly reduced-dose lumbar spine CT providing diagnostically acceptable image quality is feasible using IR in this cadaver model and may be transferred into a clinical setting.

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Section: Discussionsupporting

confidence: 87%

Highly reduced-dose CT of the lumbar spine in a human cadaver model

et al. 2020

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“…Low dose CT (<1 mSv) of the spine has already shown superior image quality in terms of anatomical and diagnostic information [19]. CT allows for much more detailed evaluation of paravertebral ossifications and degenerative changes, which supports the conclusion that modifications of the Resnick criteria are necessary when applied to CT directly.…”

Section: Discussionmentioning

confidence: 74%

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

et al. 2016

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ObjectiveTo evaluate and improve the interobserver agreement for the CT-based diagnosis of diffuse idiopathic skeletal hyperostosis (DISH).MethodsSix hundred participants of the CT arm of a lung cancer screening trial were randomly divided into two groups. The first 300 CTs were scored by five observers for the presence of DISH based on the original Resnick criteria for radiographs. After analysis of the data a consensus meeting was organised and the criteria were slightly modified regarding the definition of ‘contiguous’, the definition of ‘flowing ossifications’ and the viewing plane and window level. Subsequently, the second set of 300 CTs was scored by the same observers. κ ≥ 0.61 was considered good agreement.ResultsThe 600 male participants were on average 63.5 (SD 5.3) years old and had smoked on average 38.0 pack-years. In the first round κ values ranged from 0.32 to 0.74 and 7 out of 10 values were below 0.61. After the consensus meeting the interobserver agreement ranged from 0.51 to 0.86 and 3 out of 10 values were below 0.61. The agreement improved significantly.ConclusionsThis is the first study that reports interobserver agreement for the diagnosis of DISH on chest CT, showing mostly good agreement for modified Resnick criteria.Key Points• DISH is diagnosed on fluoroscopic and radiographic examinations using Resnick criteria • Evaluation of DISH on chest CT was modestly reproducible with the Resnick criteria • A consensus meeting and Resnick criteria modification improved inter-rater reliability for DISH • Reproducible CT criteria for DISH aids research into this poorly understood entity

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“…In the current study the CT scan settings were selected to give a DLP which would result in a suitable low effective dose, with the only requirement being that the dataset could be used for 3D reconstructions with the Ortoma software without noticeable artifacts. The settings of tube current and tube voltage are similar to those of the scanning protocol for lumbar spine CT with equivalent dose to radiography (9,21). In that project, careful subjective and objective image quality assessment were used to select the scan settings which gave the best image quality (21).…”

Section: Discussionmentioning

confidence: 99%

“…Due to advances in technology, low-dose CT applications are now available for many body parts, including the musculoskeletal system. For example, the lumbar spine can be imaged using CT with better image detail than radiography at the same dose of about 1 mSv (9), low-dose CT has been shown to be useful for pre- and postoperative imaging in scoliosis (10,11), in cervical spine trauma (12), and in staging of multiple myeloma (13). Previous studies have shown the applicability of low-dose CT in THA (7,14).…”

Section: Introductionmentioning

confidence: 99%

Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty

Geijer

Rundgren

Weber³

et al. 2017

Acta Radiol

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Background Recently, total hip arthroplasty (THA) has come to focus on restoration of individual anatomy including femoral neck anteversion and global offset (femoral and acetabular offset). Three-dimensional (3D) computed tomography (CT) data could provide a better basis for preoperative templating. The use of CT has been hampered by high radiation dose. Purpose To evaluate the effective dose used in pelvis and hip CT for THA templating. Material and Methods CT data from two clinical trials of THA were evaluated for CT scan length and volume CT dose index (CTDI). The effective doses from hip-knee-ankle CT and pelvis and hip radiography were compared. Conversion factors for effective dose for radiography were calculated using the PCXMC software. Results A reduced dose CT protocol for pelvis imaging gave a substantial dose reduction compared with standard CT, while maintaining sufficient image quality. Between the two clinical trials there was a significant reduction in effective CT dose corresponding to changes in the CT protocol ( P < 0.01). The CT dose for the latter group was similar to, but nevertheless significantly higher than for, radiography ( P < 0.01). However, in the latter group the theoretical minimum dose for CT, using the minimum scan length required by the templating software, was equal to the dose from radiography. Conclusion Although the CT dose remained higher than for radiography, potential reductions in scan length could reduce the dose further so that CT would have a comparable level of risk to radiography with the added benefit of 3D templating.

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Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice

Abstract: Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.

Cited by 27 publications

References 23 publications

Highly reduced-dose CT of the lumbar spine in a human cadaver model

Highly reduced-dose CT of the lumbar spine in a human cadaver model

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty

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