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Sharma V, Soundararajan DCR, Shetty AP, Kanna RM, Shanmuganathan R. Variation in thoracic inlet measurements and its correlation with pulmonary dysfunction in kyphoscoliotic deformities: a prospective case-control study. Spine Deform 2024; 12:1299-1309. [PMID: 38722533 DOI: 10.1007/s43390-024-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/09/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pulmonary dysfunction in thoracic kyphoscoliosis has been correlated with chest wall distortion, uneven trunk growth and restrictive pattern. The study aims to analyse the variation in thoracic inlet measurements on pulmonary dysfunction with varying curve magnitude and thoracic cage parameters. METHODS In a non-randomised, prospective case-control study, 80 consecutive patients with thoracic kyphoscoliosis were divided into 3 groups based on Cobb angle: Group 1 (31-50), Group 2 (51-80) and Group 3 (> 80). Thoracic inlet measurement was calculated by thoracic inlet index (TI) on MRI at the sternal level. Pulmonary function and thoracic cage parameters [hemi thorax height, rib-apex distance, AP chest diameter at sternal level and transverse thoracic diameter] were documented. TI values were compared with 20 age-matched asymptomatic controls. Multivariate correlation and regression analysis were performed to investigate the correlations. RESULTS The mean age of the study cohort was 14.1 ± 4.4 years, including Group 1 (6 patients), Group 2 (55 patients) and Group 3 (19 patients) versus 12.9 ± 2.2 years in controls. The mean TI was 2.8 ± 0.56 in Group 1, 3.7 ± 0.9 in Group 2 and 4.0 ± 1.12 in Group 3 versus 2.6 ± 0.43 in controls. Pulmonary dysfunction was severe with TI > 7.1 (p < 0.001) in Group 3 patients with thoracic hypokyphosis. Multivariate regression for thoracic parameters and TI > 5.6 showed significant correlation of pulmonary dysfunction in Group 2 and 3 curves with apex between T1 and T4, whereas transverse thoracic diameter, rib-apex distance and hemi thorax height were weakly associated. CONCLUSION Thoracic inlet index (TI), a neglected pre-operative variable associated with pulmonary dysfunction in thoracic kyphoscoliosis, can be evaluated on MRI without an additional cost and radiation. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Vyom Sharma
- Department of Orthopaedics, Military Hospital Khadki and Armed Forces Medical College, Pune, India
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India
| | - Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India.
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Pham TT, Le LH, Khodaei M, Zheng R, Lou E. Investigation of ultrasonic soft tissue-bone reflection coefficients correlating with curve severity in children with adolescent idiopathic scoliosis. Proc Inst Mech Eng H 2022; 236:1403-1413. [PMID: 35880904 PMCID: PMC9449449 DOI: 10.1177/09544119221114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional curvature of spine.
Children with AIS and low bone quality have higher chance to get curve
progression leading to bigger spinal curvature. In addition, bone quality
affects acoustic impedance of bone, thus influencing the reflection coefficient
of ultrasound signal from the soft tissue–bone interface. This study aimed to
estimate the bone quality of AIS patients based on the reflection coefficients
to determine the correlation of the bone quality with curve severity. A simple
bone model was used to develop an equation to calculate the reflection
coefficient value. Experiments were conducted on five different phantoms.
Acrylic was used to design a vertebral shape to study the effect of surface
roughness and inclination, including: smooth flat surface (SFS), smooth curved
surface (SCS), rough curved surface (RCS), and the rough curved inclined surface
(RCIS). A clinical study with 37 AIS patients were recruited. The estimated
reflection coefficient values of plate phantoms agreed well with the predicted
values and the maximum error was 6.7%. The reflection coefficients measured from
the acrylic-water interface for the SFS, SCS, RCS, RCIS (3° and 5°) were 0.37,
0.33, 0.28, (0.23 and 0.12), respectively. The surface roughness and inclination
increased the reflection loss. From the clinical data, the average reflection
coefficients for children with AIS were 0.11 and 0.07 for the mild curve group
and the moderate curve group, respectively. A moderate linear correlation was
found between the reflection coefficients and curve severity (r2 = 0.3). Patients with lower bone quality have observed to have
larger spinal curvature.
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Affiliation(s)
- Thanh-Tu Pham
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mahdieh Khodaei
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Rui Zheng
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Edmond Lou
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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Yang D, Lee T, Lai K, Wong Y, Wong L, Yang J, Lam T, Castelein R, Cheng J, Zheng Y. A novel classification method for mild adolescent idiopathic scoliosis using 3D ultrasound imaging. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lowered dose full-spine radiography in pediatric patients with idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1089-1095. [PMID: 29589171 DOI: 10.1007/s00586-018-5561-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To optimize our standard full-spine radiography with respect to diagnostic quality and dose. METHODS A phantom study was performed to establish an optimal posterior-anterior view (PA) full spine protocol having the lowest dose with non-inferior quality compared to standard. We then applied this protocol in 40 pediatric patients (group B). The radiographs were scored on six criteria by a pediatric radiologist and orthopedist and compared to the scores of 40 PA full spine radiographs performed in 2013 with standard protocol (group A). Radiation dose was assessed by dose area product (DAP) and effective dose (E). Statistical analysis included independent samples t test, Mann-Whitney U test and intra-class correlation coefficient (ICC). RESULTS An optimized protocol was defined (0.2 mm Cu filter, 0.87 relative exposure, with grid). Mean age was 13.3 ± 1.6 years for group A and 13.4 ± 1.7 years for group B. For group B, the mean DAP was 47.0 µGy m2 with an E of 0.13 mSv. For group A, the mean DAP was 85.3 µGy m2 with an E of 0.24 mSv. This represents a dose reduction of 45%. Mean image quality scores for group A (27.9 ± 2.4) and group B (28.1 ± 2.3) were similar (p = 0.612). Interobserver agreement was observed to be excellent (ICC 0.92). CONCLUSION This study demonstrates that a low-dose full-spine radiograph can be performed in patients with idiopathic scoliosis without loss of image quality. These slides can be retrieved under Electronic Supplementary Material.
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Kim JS, Yoon SW, Seo DN, Nam SR, Kim JM. Evaluation of the Patient Effective Dose in Whole Spine Scanography Based on the Automatic Image Pasting Method for Digital Radiography. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e22514. [PMID: 27110338 PMCID: PMC4835671 DOI: 10.5812/iranjradiol.22514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/14/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whole spine scanography (WSS) is a radiologic examination that requires whole body X-ray exposure. Consequently, the amount of patient radiation exposure is higher than the radiation dose following routine X-ray examination. OBJECTIVES Several studies have evaluated the patient effective dose (ED) following single exposure film-screen WSS. The objective of this study was to evaluate patient ED during WSS, based on the automatic image pasting method for multiple exposure digital radiography (APMDR). Further, the calculated EDs were compared with the results of previous studies involving single exposure film-screen WSS. PATIENTS AND METHODS We evaluated the ED of 50 consecutive patients (M:F = 28:22) who underwent WSS using APMDR. The anterior-posterior (AP) and lateral (LAT) projection EDs were evaluated based on the Monte Carlo simulation. RESULTS Using APMDR, the mean number of exposures was 6.1 for AP and 6.5 for LAT projections. LAT projections required more exposures (6.55%) than AP projections. The mean ED was 0.6276 mSv (AP) and 0.6716 mSv (LAT). The mean ED for LAT projections was 0.6061 mSv in automatic exposure control (AEC) and 0.7694 mSv in manual mode. The relationship between dose-area-product (DAP) and ED revealed a proportional correlation (AP, R(2) = 0.943; LAT, R(2) = 0.773). Compared to prior research involving single exposure screen-film WSS, the patient ED following WSS using APMDR was lower on AP than on LAT projections. CONCLUSION Despite multiple exposures, ED control is more effective if WSS is performed using APMDR in the AEC mode.
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Affiliation(s)
- Jung-Su Kim
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - Sang-Wook Yoon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, South Korea
| | - Deok-Nam Seo
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - So-Ra Nam
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - Jung-Min Kim
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
- Corresponding author: Jung-Min Kim, Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea. Tel: +82-2940-2577, Fax: +82-29402829, E-mail:
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Mundis GM, Pawelek JB, Nomoto EK, Hennessy MW, Yaszay B, Akbarnia BA. Longitudinal Pilot Analysis of Radiation Exposure During the Course of Growing Rod Treatment for Early-Onset Scoliosis. Spine Deform 2016; 4:55-58. [PMID: 27852501 DOI: 10.1016/j.jspd.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/02/2015] [Accepted: 06/09/2015] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Retrospective consecutive case series. OBJECTIVES To estimate the amount of ionizing radiation (IR) exposure in growing rod (GR) surgery for early-onset scoliosis. SUMMARY OF BACKGROUND DATA There is substantial evidence of the health hazards attributed to IR exposure. However, no studies have estimated the amount of IR exposure in GR surgery. MATERIALS AND METHODS A consecutive single-center series of GR patients were retrospectively reviewed. Of 28 total patients, 24 had a minimum 2-year follow-up and complete records available for analysis. All spine-related IR imaging studies excluding intraoperative fluoroscopy were tabulated and IR estimated based on historical controls in millisieverts (mSv). RESULTS Initial x-ray evaluation for scoliosis was performed at a mean age of 4.0 years (range = birth to 9.7). Mean radiographic period was 8.5 years (range = 2.2 to 19.4). There was a statistically significant inverse correlation between patient age at time of initial IR and total mean IR (p < .05). Total IR was 3.4 times greater than that of estimated background radiation (2.4 mSv per year). Mean IR before index surgery and during the first postoperative year were 22.41 mSv and 10.78 mSv, respectively. Annual IR after the first postoperative year averaged 7.02 mSv (range = 2.25 to 13.45). Patients who underwent at least one revision surgery experienced significantly higher IR than nonrevision patients (79.95 vs. 46.58 mSv; p < .05). Overall, 89% of total IR was attributed to x-rays and 11% from computed tomography. CONCLUSIONS Compared to the general public, GR patients had 3.4 times more IR than the estimated background radiation for the same duration of time. Younger patients and those requiring revision surgery had significantly higher IR doses. This study underscores the importance of recognizing the amount of IR used in the management of GR patients and its potential long-term risks. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory M Mundis
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA 92037, USA.
| | - Jeff B Pawelek
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA 92037, USA
| | - Edward K Nomoto
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA 92037, USA
| | - Michael W Hennessy
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA 92037, USA
| | - Burt Yaszay
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Behrooz A Akbarnia
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA 92037, USA
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Damet J, Fournier P, Monnin P, Sans-Merce M, Ceroni D, Zand T, Verdun FR, Baechler S. Occupational and patient exposure as well as image quality for full spine examinations with the EOS imaging system. Med Phys 2014; 41:063901. [DOI: 10.1118/1.4873333] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Radiographic parameters improve lower extremity prosthetic alignment. J Child Orthop 2013; 7:543-50. [PMID: 24432119 PMCID: PMC3886358 DOI: 10.1007/s11832-013-0530-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/03/2013] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The goal of prosthetic fitting is to provide comfort and functionality to the patient. It is thought that incorporating the use of standing anterior-posterior long leg radiographs (LLR) into the fitting of lower extremity prostheses will provide an objective guide when making adjustments, and be a better assessment of alignment. This study compares prosthetic alignment before and after radiography-guided adjustments. METHOD This retrospective study was performed at a multidisciplinary amputee clinic on patients with congenital and/or acquired limb deficiencies. Their prosthetic alignment was evaluated by LLR and adjusted as needed. Satisfactory alignment was defined as a mechanical axis angular deviation of ≤1° and a leg length discrepancy of ≤10 mm. RESULTS A total of 45 unique prostheses from 24 subjects (10 female and 14 male) were included. Post-adjustment radiographs were obtained from 29 prostheses. After the initial prosthetic fitting, the probability of a satisfactory fit was 20.0 % (95 % CI 10.9-34.9 %). Following the baseline adjustment, the probability of a satisfactory fit improved to 53.3 % (95 % CI 37.5-70.9 %). After adjustment number 4, the probability of a satisfactory fit further improved to 76.7 % (95 % CI 41.9-98.0 %). There were also significant improvements in distal offset distance (p = 0.0040) and leg length discrepancy (p = 0.0206). The distal offset distance decreased by an average of 10.7 mm (95 % CI 3.6-17.8), and leg length discrepancy decreased by an average of 3.0 mm (95 % CI 00.48-5.5). CONCLUSIONS The addition of LLRs to existing fitting methods significantly improves prosthetic alignment and length.
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Kalra MK, Quick P, Singh S, Sandborg M, Persson A. Whole spine CT for evaluation of scoliosis in children: feasibility of sub-milliSievert scanning protocol. Acta Radiol 2013; 54:226-30. [PMID: 23138023 DOI: 10.1258/ar.2012.110625] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optimization of CT radiation dose is important for children due to their higher risk of radiation-induced adverse effects. Anatomical structures with high inherent contrast, such as bones can be imaged at very low radiation doses by optimizing scan parameters. PURPOSE To assess feasibility of sub-milliSievert whole spine CT scanning protocol for evaluation of scoliosis in children. MATERIAL AND METHODS With approval of the ethical board, we performed whole spine CT for evaluation of scoliosis in 22 children (age range, 3-18 years; mean age, 13 years; 13 girls, 9 boys) on a 128-slice dual source multidetector-row CT scanner. Lowest possible quality reference mAs value (image quality factor for xy-z automatic exposure control or xyz-AEC, CARE Dose 4D) was selected on a per patient basis. Remaining parameters were held constant at 3.0:1 pitch, 128 × 0.6 mm detector collimation, 115.2 mm table feed per gantry rotation, 100 kVp, and 1 and 3 mm reconstructed sections. Average mAs, projected estimated dose savings with AEC, computed tomography dose index volume (CTDI vol), and dose length product (DLP) were recorded. Artifacts were graded on a four-point scale (1, no artifacts; 4, severe artifacts). Ability to identify vertebral and pedicular contours, and measure pedicular width and degree of vertebral rotation was graded on a three-point scale (1, unacceptable; 3, excellent). RESULTS All CT examinations were deemed as reliable for identifying vertebral and pedicular contours as well as for measuring pedicular width (5.9 ± 1.6 mm) and degree of vertebral rotation (28.7 ± 23.4°). Mean objective image noise and signal to noise ratio (SNR) were 57.5 ± 21.5 and 4.7 ± 2.3, respectively. With a mean quality reference mAs of 13, the scanner employed an average actual effective mAs of 10 ± 3.8 (range, 6-18 mAs) with an estimated radiation dose saving of 43.5 ± 16.3% with xyz-AEC compared with fixed mAs. The mean CTDI, DLP, and estimated effective doses were 0.4 ± 0.1 mGy (0.2-0.7 mGy), 21 ± 10 mGy.cm (8-41 mGy.cm), and 0.3 ± 0.1 mSv (0.12-0.64 mSv), respectively. CONCLUSION Radiation dose for whole spine CT for evaluation of scoliosis in children can be minimized to less than one-third of a milliSievert while maintaining diagnostic image quality.
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Affiliation(s)
- Mannudeep K Kalra
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping University Hospital, Linkoping, Sweden
- Massachusetts General Hospital Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Petter Quick
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping University Hospital, Linkoping, Sweden
| | - Sarabjeet Singh
- Massachusetts General Hospital Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Sandborg
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping University Hospital, Linkoping, Sweden
- Department of Radiophysics, Linkoping University Hospital, Linkoping, Sweden
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping University Hospital, Linkoping, Sweden
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Mogaadi M, Ben Omrane L, Hammou A. Effective dose for scoliosis patients undergoing full spine radiography. RADIATION PROTECTION DOSIMETRY 2012; 149:297-303. [PMID: 21737443 DOI: 10.1093/rpd/ncr254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Scoliotic patients underwent many radiological examinations during their control and treatment periods. Nowadays, few studies have calculated effective dose which is the primary indicator of radiation risk. In this study, the PCXMC program is used to calculate the effective doses associated with scoliosis radiography. Five age groups of patients, proposed by the National Radiological Protection Board, have been chosen: <1, 1-4, 5-9, 10-15 and ≥16 y (adult patients). Patient and radiographic data were collected from 99 patient examinations for both anteroposterior and lateral full spine X-ray projections. Results showed the effective dose ranged from 118 to 1596 μSv for the frontal projection and from 97 to 1370 μSv for the lateral projection, with patient age varying from 3 months to 22 y. This study presents the effective dose against patient age and demonstrates the necessity to optimise patient protection for this type of examination.
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Affiliation(s)
- M Mogaadi
- Department of Biology, University of Bizerte, Bizerte, Tunisia.
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Knott P, Mardjetko S, Tager D, Hund R, Thompson S. The influence of body mass index (BMI) on the reproducibility of surface topography measurements. SCOLIOSIS 2012. [PMCID: PMC3305309 DOI: 10.1186/1748-7161-7-s1-o18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- Geetika Khanna
- Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, Saint Louis, MO 63110, USA.
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Mettler FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248:254-63. [PMID: 18566177 DOI: 10.1148/radiol.2481071451] [Citation(s) in RCA: 1318] [Impact Index Per Article: 82.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.
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Affiliation(s)
- Fred A Mettler
- Department of Radiology and Nuclear Medicine, New Mexico Veterans Administration Healthcare System, 1501 San Pedro Blvd, Albuquerque, NM 87108, USA.
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Gialousis G, Yiakoumakis EN, Makri TK, Papadoupoulou D, Karlatira M, Karaiskos P, Papaodysseas S, Evlogias N, Dimitriou PA, Georgiou EK. Comparison of dose from radiological examination for scoliosis in children among two pediatric hospitals by Monte Carlo simulation. HEALTH PHYSICS 2008; 94:471-478. [PMID: 18403968 DOI: 10.1097/01.hp.0000303105.91168.ea] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The radiation exposures of children undergoing full spine radiography were investigated in two pediatric hospitals in Greece. Entrance surface kerma (Ka,e) was assessed by thermoluminescence dosimetry and patient's effective dose (E) was estimated by Monte Carlo simulation. All required information regarding patient age and sex, the irradiation geometry, the x-ray spectra, and other exposure parameters (tube voltage and current) were registered as well. Values of Ka,e were measured to range from 0.22 mGy to 2.12 mGy, while E was estimated to range from 0.03 mSv to 0.47 mSv. In general, all values were greater in one of the two hospitals, as higher tube currents and exposure times were used in the examinations because of the difference in radiographers' training and practice. Moreover, dose to red bone marrow was found to be between 0.01 to 0.23 mSv and dose to breast ranged between 0.02 and 1.05 mSv depending on the age, projection, and hospital. These values are comparable with literature sources.
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Affiliation(s)
- G Gialousis
- Medical Physics Department, Medical School, University of Athens, 75 Mikras Asias Str., Goudi 11527, Athens, Greece.
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Scoliose idiopathique. Stratégie diagnostique, physiopathologie et analyse de la déformation. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0246-0521(04)29822-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Gialousis GI, Yakoumakis EN, Papadopoulou DI, Makri TK, Yakoumakis NE, Dimitriou PA, Georgiou EK. Differences in effective dose and energy imparted estimation from PA–AP, RLAT–LLAT projections in pediatric full spine x-ray examination using the Monte Carlo technique. Phys Med Biol 2005; 51:287-97. [PMID: 16394339 DOI: 10.1088/0031-9155/51/2/007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Effective dose (E) and energy imparted (epsilon) can be used to quantify the risk of radiation-induced carcinogenesis or hereditary effects arising from radiographic exposures. When the children are examined or treated for idiopathic scoliokyphosis it is important to estimate E and epsilon in the patients due to full spine x-ray examination. The aim of this study is to calculate E and epsilon in the case of children of 5 and 10 years old who undergo full spine x-ray examination using the Monte Carlo approach. Dose area product (DAP) and entrance surface dose (ESD) were also used. AP, PA, RLAT, LLAT projections are simulated by using appropriate energy spectra. According to the results, the effective dose (E) and the energy imparted (epsilon) are smaller at PA projection than AP, although for spine the opposite occurs, in agreement with previous studies. On the other hand, E and epsilon do not differ statistically among RLAT and LLAT projections. Moreover, the role of lung and bone as tissue inhomogeneities in epsilon is shown to be very important.
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Affiliation(s)
- George I Gialousis
- Medical Physics Department, Medical School, University of Athens, 75, Mikras Asias Str, Goudi 115 27, Athens, Greece
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17
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Lee CI, McLean D, Robinson J. Measurement of effective dose for paediatric scoliotic patients. Radiography (Lond) 2005. [DOI: 10.1016/j.radi.2004.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Khouri N, Vialle R, Mary P, Marty C. Scoliose idiopathique. Stratégie diagnostique, physiopathologie et analyse de la déformation. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcrho.2003.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McLean D, Malitz N, Lewis S. Survey of effective dose levels from typical paediatric CT protocols. AUSTRALASIAN RADIOLOGY 2003; 47:135-42. [PMID: 12780441 DOI: 10.1046/j.0004-8461.2003.01141.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Concern over reported large radiation doses leading to a high cancer risk for paediatric CT patients has prompted considerable investigation in paediatric CT. The recent release of software from Germany has allowed effective doses to be calculated from CT protocol information and radiation measurement for standard paediatric patient sizes for both sexes. An initial study has been undertaken in nine radiology departments, four of which were dedicated paediatric departments, for routine chest and abdominal CT procedures. The dose calculation software is based on Monte Carlo simulation of X-ray conditions during a CT procedure and utilized a 'tomographic' phantom model of a 7-year-old child and an 8-week-old baby to allow calculation of organ dose and hence effective dose. Results of the survey indicate that effective doses were higher for females than males, and higher for abdominal procedures. Slightly higher effective doses were calculated for the child compared to the baby. All centres but one recorded lower effective doses with their current protocols than if they had used recommended CT protocols found in the literature. Analysis of the survey data indicates that scan parameters are the main cause of dose variations, although the type of scanner can affect dose by a factor of 2 (when comparing different units) as well as variation in anatomy scanned in protocols. Dose reduction appears to be most closely linked with reduced mAs and increased pitch as expected. The calculation of effective dose appears to be a key factor in assessing CT protocols, particularly for paediatric patients.
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Affiliation(s)
- Donald McLean
- School of Medical Radiation Sciences, University of Sydney, Sydney, Australia.
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Jaramillo D, Poussaint TY, Grottkau BE. Scoliosis: evidence-based diagnostic evaluation. Neuroimaging Clin N Am 2003; 13:335-41, xii. [PMID: 13677811 DOI: 10.1016/s1052-5149(03)00023-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article summarizes the evidence behind the imaging evaluation of scoliosis, which is primarily performed with plain radiographs and MR imaging. Issues related to the radiographic evaluation of spinal curvature include interobserver variability of scoliosis measurements and the radiologist's detection of unexpected findings. The effects of radiation exposure during scoliosis evaluation and strategies to minimize radiation dose are summarized. The use of MR imaging in idiopathic scoliosis is discussed, with special attention to imaging groups at higher risk for underlying pathology of the neural axis.
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Affiliation(s)
- Diego Jaramillo
- Division of Pediatric Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Theocharopoulos N, Perisinakis K, Damilakis J, Varveris H, Gourtsoyiannis N. Comparison of four methods for assessing patient effective dose from radiological examinations. Med Phys 2002; 29:2070-9. [PMID: 12349928 DOI: 10.1118/1.1500769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Three methods of indirect effective dose estimation were reviewed and compared to a direct effective dose determination method. An anthropomorphic phantom and thermoluminescence dosimetry were used to obtain dosimetric data associated with anterior-posterior (AP) abdominal radiography, posterior-anterior (PA) chest radiography, PA head radiography, and AP heart fluoroscopy. Effective dose was determined using: (i) organ specific dose values directly determined by thermoluminescence dosimeters, (ii) data published by National Radiological Protection Board (NRPB) and entrance surface dose (ESD), (iii) NRPB data and dose area product (DAP), (iv) energy imparted derived from DAP. The effective dose values estimated from the Rando phantom measurements were 161, 32.3, and 8.4 microSv/projection for the abdomen, chest, and head radiographs, respectively. Cardiac fluoroscopy yielded an effective dose value of 111 microSv/min. The effective dose values obtained indirectly using NRPB data and DAP were in good agreement with directly assessed values in all simulated exposures (difference <8%). The effective doses using NRPB data and ESD values differed from directly assessed values by less than 15% for the radiographic exposures and 60% for heart fluoroscopy. The energy imparted method yielded 136, 31, and 6.6 microSv/projection for the abdomen, chest, and head radiographs, respectively, and 111 microSv/min for heart fluoroscopy. Indirect patient effective dose determination using the NRPB dosimetric data and the measured value of incident radiation allows for reliable patient effective dose estimates. The use of DAP rather than ESD is recommended because it yields accurate results even for complex radiologic exposures involving fluoroscopy. The value of energy imparted may be used for the accurate determination of patient effective dose, especially when specific organ dose values are not of interest. The calculation of energy imparted with the use of EAP provides a reliable starting point for estimation of effective dose from radiologic examinations for which dosimetric data are not provided by NRPB.
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