Diagnostic Imaging of Spinal Deformities: Reducing Patients Radiation Dose With a New Slot-Scanning X-ray Imager

Study Design. Clinical trial comparing image quality and entrance dose between Biospace EOS system, a new slot-scanning radiographic device, and a Fuji FCR 7501S computed radiography (CR) system for 50 patients followed for spinal deformities. Objective. Based on their physical properties, slot-scanners show the potential to produce image quality comparable to CR systems using less radiation. This article validates this assertion by comparing a new slot-scanner to a CR system through a wide-ranging evaluation of dose and image quality for scoliosis examinations. Summary of Background Data. For each patient included in this study, lateral and posteroanterior images were acquired with both systems. For each system, entrance dose was measured for different anatomic locations. Methods. Dose and image quality being directly related, comparable images were obtained using the same radiograph tube voltage on both systems while tube currents were selected to match signal-to-noise ratios on a phantom. Different techniques were defined with respect to patient's thickness about the iliac crests. Given dose amplitudes expected for scoliosis examinations, optically stimulated luminescence dosimeters were chosen as optimal sensors. Two radiologists and 2 orthopedists evaluated the images in a randomized order using a questionnaire targeting anatomic landmarks. Visibility of the structures was rated on a 4 level scale. Image quality assessment was analyzed using a Wilcoxon signed-rank tests. Results. Average skin dose was reduced from 6 to 9 times in the thoracoabdominal region when using the slot-scanner instead of CR. Moreover, image quality was significantly better with EOS for all structures in the frontal view (P < 0.006) and lateral view (P < 0.04), except for lumbar spinous processes, better seen on the CR (P < 0.003). Conclusion. We established that the EOS system offers overall enhanced image quality while reducing drastically the entrance dose for the patient.

[1]  D. Brenner,et al.  Computed tomography--an increasing source of radiation exposure. , 2007, The New England journal of medicine.

[2]  I. Tsalafoutas,et al.  Radiation dose considerations in common paediatric X-ray examinations , 2003, Pediatric Radiology.

[3]  J. Boice,et al.  Breast cancer in women with scoliosis exposed to multiple diagnostic x rays. , 1989, Journal of the National Cancer Institute.

[4]  Benoit Godbout,et al.  Vertebral pose estimation using edge-based pattern matching and stereoradiographic 3D reconstruction of the spine , 2004, CARS.

[5]  J. D. De Guise,et al.  Physical characteristics of a low-dose gas microstrip detector for orthopedic x-ray imaging. , 2005, Medical physics.

[6]  R. Sievert,et al.  Book Reviews : Recommendations of the International Commission on Radiological Protection (as amended 1959 and revised 1962). I.C.R.P. Publication 6. 70 pp. PERGAMON PRESS. Oxford, London and New York, 1964. £1 5s. 0d. [TB/54] , 1964 .

[7]  David J. Brenner,et al.  Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative , 2002, Pediatric Radiology.

[8]  J Persliden,et al.  Digital radiography of scoliosis with a scanning method: initial evaluation. , 2001, Radiology.

[9]  Jolanta Hansen,et al.  Optimisation of scoliosis examinations in children , 2003, Pediatric Radiology.

[10]  D. Blanc,et al.  European guidelines on quality criteria for diagnostic radiographic images , 1998 .

[11]  P. Karaiskos,et al.  COMPARISON OF DOSE FROM RADIOLOGICAL EXAMINATION FOR SCOLIOSIS IN CHILDREN AMONG TWO PEDIATRIC HOSPITALS BY MONTE CARLO SIMULATION , 2008, Health physics.

[12]  Marilyn Stovall,et al.  Breast Cancer Mortality After Diagnostic Radiography: Findings From the U.S. Scoliosis Cohort Study , 2000, Spine.

[13]  Ehsan Samei,et al.  Fundamental imaging characteristics of a slot-scan digital chest radiographic system. , 2004, Medical physics.

[14]  Ehsan Samei,et al.  Comparative scatter and dose performance of slot-scan and full-field digital chest radiography systems. , 2005, Radiology.

[15]  C. M. Bone,et al.  The risk of carcinogenesis from radiographs to pediatric orthopaedic patients. , 2000, Journal of pediatric orthopedics.

[16]  J.A. De Guise,et al.  Surface reconstruction from planar x-ray images using moving least squares , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.