Should Plain Films of the Lumbar Spine be Taken in the Posterior-to-Anterior or Anterior-to-Posterior Position? A Study Using Decision Analysis

Young, Kenneth J.

doi:10.1016/j.jmpt.2007.01.013

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Several studies have investigated the x-ray dose optimisation techniques of lumbar spine radiography. However, the majority focused on the manipulation of a single imaging parameter instead of considering the imaging parameters as combinations [2,3,7,9,[14][15][16]25]. In this study, the baseline protocol was determined by considering the different imaging parameters proposed by the current literature.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, the published literature that identified optimisation in radiography merely analysed the impact of a single-exposure parameter instead of taking into account all of them. The most widely studied exposure parameters identified in the literature were the source-to-detector distance (SDD) [7][8][9], tube voltage (kVp), tube current × exposure time product (mAs) [9,10], additional beam filtrations [11][12][13], and type of projection (anterior-posterior, posterior-anterior, horizontal beam lateral) [2,[14][15][16][17]. These studies showed that a posterior-anterior lumbar spine radiogram was associated with a 65% ED reduction when compared to the anterior-posterior due to the attenuation of primary beam by the iliac bones [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

2020

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Background: To investigate lateral lumbar spine radiography technical parameters for reduction of effective dose whilst maintaining image quality (IQ). Methods: Thirty-six radiograms of an anthropomorphic phantom were acquired using different exposure parameters: source-to-detector distance (SDD) (100, 130 or 150 cm), tube potential (75, 85 or 95 kVp), tube current × exposure time product (4.5, 9, 18 mAs) and additional copper (Cu) filter (no filter, 0.1-, 0.2-, or 0.3-mm thickness. IQ was assessed using an objective approach (contrast-to-noise-ratio [CNR] calculation and magnification measurement) and a perceptual approach (six observers); ED was estimated using the PCXMC 2.0 software. Descriptive statistics, paired t test, and intraclass correlation coefficient (ICC) were used. Results: The highest ED (0.022 mSv) was found with 100 cm SSD, 75 kVp, 18 mAs, and without Cu filter, whilst the highest CNR (7.23) was achieved at 130 cm SSD, 75 kVp, 18 mAs, and without Cu filter. The lowest ED and CNR were generated at 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. All observers identified the relevant anatomical structures on all images with the lowest ED and IQ. The intra-observer (0.61-0.79) and inter-observer (0.55-0.82) ICC ranged from moderate to excellent. Conclusion: All relevant anatomical structures were identified on the lateral lumbar spine radiographs despite using low-dose protocols. The lowest ED (0.002 mSv) was obtained with 150 cm SDD, 95 kVp, 4.5 mAs, and 0.3-mm Cu filter. Further technical and clinical studies are needed to verify these preliminary findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

2020

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“…A preference for AP positioning comes from the fact that positioning the spine closer to the image receptor minimises magnification and distortion (3). Previous research has suggested that although PA projections do demonstrate increased magnification this is generally considered to be significant enough to drastically affect the quality of the resultant image (4).…”

Section: Introductionmentioning

confidence: 99%

AP versus PA positioning in lumbar spine computed radiography: Image quality and individual organ doses

Davey

England

2015

Radiography

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2 ABSTRACTPurpose: Radiological imaging examinations must be optimised in order to ensure that the radiation dose is kept as low as reasonably possible (ALARP). The aim of this study was to compare anteroposterior (AP) and posteroanterior (PA) projections of the lumbar spine, at various kVp increments, in order to establish optimum parameters.Methods: An anthropomorphic phantom was imaged in both the AP/PA projections and at various kVp increments. Acquisitions were undertaken using a Wolverson Acroma X-ray unit and processed using an Agfa computed radiography (CR) unit. The entrance surface dose was recorded and converted to effective and organ doses using PCXMC 2.0 software. Five observers were then asked to evaluate the images, using a two-alternative force choice (2AFC) approach and a scale based on EC guidelines. Results:The PA projection lowered the mean effective dose by 19.8% and also the mean absorbed dose to the stomach (70.4%), colon (61.1%), remainder tissues (33.2%), ovaries (7.3%) and testes (15.9%). However, this was at the expense of slightly inferior image quality, not statistically significant. For AP projections, a higher kVp is a further option for dose reduction.Conclusion: Dose optimisation requires the production of an image that is acceptable for the purpose intended. Based on ALARP, and when taking into consideration the dose reductions in this study, it may now be time to routinely use PA projections when imaging the lumbar spine. The use of a higher kVp should also be considered as an option but would be more useful for AP projections.3

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Attitudes of medical imaging technologists on use of gonad shielding in general radiography

et al. 2012

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Purpose: Gonad shielding is an important way to address the ‘as low as reasonably achievable’ (ALARA) requirement in radiography. However, its use relies on the attitudes of medical imaging technologists (MITs) to consistently adhere to professional conduct requirements relating to the application of gonad shielding. The purpose of this study was to investigate the attitudes of Western Australian (WA) MITs to the use of gonad shielding in general radiography and also to explore the variables influencing these attitudes. Methods: A questionnaire regarding MITs' attitudes towards gonad shielding was developed based on relevant literature and distributed to MITs working in general radiography employed by public and private clinical centres in WA metropolitan and rural regions. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (chi‐square, t‐test and analysis of variance) were used to analyse the responses of the multiple choice (MC) and 5‐point scale questions from the returned questionnaires. Results: The questionnaire response rate was 44.6% (127/285). It was found that WA MITs perceived gonad shielding as important (mean: 3.8) and that adequate education had been provided (mean: 3.1). However, statistically significant attitude variations existed among MITs from different employment sectors (P < 0.01), equipment awareness (P < 0.05), genders (P < 0.005) and educational qualifications (P < 0.05). Conclusion: Overall, WA MITs have positive and appropriate attitudes to the use of gonad shielding in general radiography. However, statistically significant attitude variations existed among MITs. Possible directions for improvement include the provision of gonad shielding protocol in each x‐ray room in clinical departments and the enhancement of education and training of shielding application. This potentially will lead to improved consistency in the appropriate application of gonad protective shielding.

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Should Plain Films of the Lumbar Spine be Taken in the Posterior-to-Anterior or Anterior-to-Posterior Position? A Study Using Decision Analysis

Cited by 7 publications

References 17 publications

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

Effective dose and image optimisation of lateral lumbar spine radiography: a phantom study

AP versus PA positioning in lumbar spine computed radiography: Image quality and individual organ doses

Attitudes of medical imaging technologists on use of gonad shielding in general radiography

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