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. 2014 Aug;20(3):251-257.
doi: 10.1016/j.radi.2014.03.010.

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

F E Mellor  1 , P Thomas  2 , A Breen  3
Affiliations

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

F E Mellor et al. Radiography (Lond). 2014 Aug.

Abstract

Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy.

Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA).

Results and conclusion: The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm2), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm2) is lower than for four view functional radiography (7.34 Gy cm2). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm2) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.

Keywords: Continuous motion; Flexion-extension; Inter-vertebral; Low back pain; Movement disorders; Spine kinematics.

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Figures

Figure 1
Figure 1
Diagram of the passive motion table for QF of the lumbar spine. Patients lie in either a supine or lateral decubitus position with L3 centred to the fulcrum with knees bent to flatten the lumbar lordosis. The table swings through an arc of 40° each way.
Figure 2
Figure 2
The reported DAP of AP and lateral lumbar spine radiographs compared to quantitative fluoroscopy and local data for 2 view (flexion and extension) functional radiographs.
Figure 3
Figure 3
The reported DAP of combined lumbar spine radiographs (AP + lateral) compared to quantitative fluoroscopy and local data for functional radiographs. *Data for Norway has been reported as 4.2 Gy cm2 and 4.4 Gy cm2 in two separate references. The average of 4.3 Gy cm2 is shown here.
Figure 4
Figure 4
Reported effective dose for lumbar spine radiographs (AP or lateral) compared to quantitative fluoroscopy.
Figure 5
Figure 5
The effective dose of combined lumbar spine radiographic series compared to quantitative fluoroscopy and local data for functional radiographs.
See this image and copyright information in PMC

References

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