Effect of a full and empty bladder on radiation dose to the uterus, ovaries and bladder from lumbar spine CT and X-ray examinations.

Abstract A local survey was conducted, to evaluate the radiation dose to adult patients who underwent diagnostic X-ray examinations. Patient-related and technical data were recorded, in 1504 patients, for each of the 11 individual projections, of the 7 most common examinations performed in an X-ray room, with 1 digital radiography system. The patient entrance surface air kerma (ESAK) and the effective dose (ED) were calculated based on the X-ray tube output and the exposure parameters, as well as utilisation of suitable conversion coefficients, respectively. The 75th percentiles of the distribution of the ESAK and kerma area product (KAP) values were also established. The mean, median and 75th percentiles were compared with the national reference levels and the most common values reported at the European level through the DOSE DATAMED II project. The corresponding ED values were also compared with the average values reported for all European countries. The mean ESAK, KAP and ED values along with the uncertainty U values for chest PA, chest LAT, cranium AP, cranium LAT, cervical spine AP, cervical spine LAT, lumbar spine AP, lumbar spine LAT, pelvis AP, abdomen AP, kidneys and urinary bladder (KUB) AP were 0.12 (0.001) mGy, 0.66 (0.023) mGy, 1.01 (0.034) mGy, 0.69 (0.098) mGy, 0.72 (0.014) mGy, 0.63 (0.011) mGy, 4.12 (0.050) mGy, 5.74 (0.082) mGy, 2.57 (0.024) mGy, 1.94 (0.017) mGy, 2.47 (0.073) mGy, and 0.09 (0.001) Gy cm2, 0.38 (0.012) Gy cm2, 0.32 (0.009) Gy cm2, 0.27 (0.052) Gy cm2, 0.17 (0.004) Gy cm2, 0.21 (0.006) Gy cm2, 1.18 (0.018) Gy cm2, 1.86 (0.023) Gy cm2, 1.41 (0.012) Gy cm2, 1.27 (0.010) Gy cm2, 1.28 (0.038) Gy cm2, as well as 0.01 (0.0001) mSv, 0.05 (0.0016) mSv, 0.02 (0.0006) mSv, 0.01 (0.0012) mSv, 0.03 (0.0008) mSv, 0.03 (0.0006) mSv, 0.26 (0.0038) mSv, 0.17 (0.0022) mSv, 0.20 (0.0016) mSv, 0.23 (0.0018) mSv, 0.23 (0.0068) mSv, respectively. The 75th percentiles along with the uncertainty U values for chest PA, chest LAT, cranium AP, cranium LAT, cervical spine AP, cervical spine LAT, lumbar spine AP, lumbar spine LAT, pelvis AP, abdomen AP, kidneys and urinary bladder (KUB) AP were 0.14 (0.006) mGy, 0.88 (0.031) mGy, 1.22 (0.049) mGy, 0.94 (0.098) mGy, 0.93 (0.027) mGy, 0.78 (0.013) mGy, 5.16 (0.073) mGy, 7.24 (0.134) mGy, 2.96 (0.047) mGy, 2.59 (0.036) mGy, 3.07 (0.116) mGy, as well as 0.10 (0.0006) Gy cm2, 0.51 (0.017) Gy cm2, 0.37 (0.020) Gy cm2, 0.33 (0.040) Gy cm2, 0.23 (0.007) Gy cm2, 0.26 (0.011) Gy cm2, 1.50 (0.036) Gy cm2, 2.26 (0.035) Gy cm2, 1.61 (0.023) Gy cm2, 1.67 (0.017) Gy cm2, 1.56 (0.069) Gy cm2, in terms of ESAK and KAP values, respectively. The results were significantly lower compared with the national reference levels, the most common DRL values reported at the European level and other previously reported dose values. Patient dose surveys could contribute towards optimising radiation protection for patients, therefore, highlighting the necessity to increase the awareness and knowledge of the radiation dose in conjunction with the required image quality.

Download Full-text

Radiation dose levels of thoracic–lumbar spine CT in pediatric trauma patients and assessment of scan parameters for dose optimization

Pediatric Radiology ◽

10.1007/s00247-021-05170-0 ◽

2021 ◽

Author(s):

Sevtap Arslan ◽

Mehmet Ruhi Onur ◽

Yasin Sarıkaya ◽

H. Nursun Özcan ◽

Mithat Haliloğlu ◽

...

Keyword(s):

Lumbar Spine ◽

Radiation Dose ◽

Pediatric Trauma ◽

Dose Optimization ◽

Trauma Patients ◽

Spine Ct ◽

Dose Levels

Download Full-text

Can Diffuse Idiopathic Skeletal Hyperostosis Be Diagnosed by Plain Lumbar Spine X-Ray Findings Alone?

Global Spine Journal ◽

10.1177/2192568220948038 ◽

2020 ◽

pp. 219256822094803

Author(s):

Hiroshi Misaki ◽

Tadao Morino ◽

Masayuki Hino ◽

Yusuke Murakami ◽

Hiroshi Imai ◽

...

Keyword(s):

Lumbar Spine ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Thoracolumbar Spine ◽

Ct Scanning ◽

Retrospective Case ◽

Cutoff Value ◽

X Ray ◽

Ct Findings ◽

Spine Ct ◽

Before And After

Study Design: Retrospective case-control study Objectives: To determine whether diffuse idiopathic skeletal hyperostosis (DISH) can be diagnosed based on anterior longitudinal ligamental ossification in the lumbar spine using plain lumbar spine X-ray images. Methods: This study included 100 patients (59 men and 41 women; mean age, 64.8 ± 13.8 years; range, 27-89 years) who underwent computed tomography (CT) of the chest to the pelvis in our hospital and plain lumbar spine radiography within 6 months before and after CT scanning. DISH was diagnosed based on the thoracolumbar spine CT findings using Resnick’s diagnostic criteria. The patients were grouped according to DISH diagnosis into the DISH (+) and DISH (−) groups. On the frontal and lateral lumbar spine X-ray images, each spinal level from Th11/12 to L5/S was scored based on the Mata scoring system. The distribution of the Mata scores was compared between the 2 groups. Results: Forty (40%) patients were diagnosed with DISH based on the CT findings. A cutoff value ≥8 provided a sensitivity of 75% and specificity of 100% for diagnosing DISH, thus, indicating the validity of the cutoff value. In the DISH (−) group, no patient had ≥3 consecutive spinal levels with a Mata score ≥2, suggesting that DISH can be diagnosed on the basis of at least 3 consecutive spinal levels with a Mata score ≥2. Conclusion: On lumbar spine X-ray images of the T11/12 to L5/S levels, a Mata score ≥2 for at least 3 consecutive levels or a total score ≥8 strongly indicates the presence of DISH.

Download Full-text

PATIENT DOSE IN DIGITAL RADIOGRAPHY UTILISING BMI CLASSIFICATION

Radiation Protection Dosimetry ◽

10.1093/rpd/ncy194 ◽

2018 ◽

Vol 184 (2) ◽

pp. 155-167 ◽

Cited By ~ 4

Author(s):

Vasileios I Metaxas ◽

Gerasimos A Messaris ◽

Aristea N Lekatou ◽

Theodore G Petsas ◽

George S Panayiotakis

Keyword(s):

Lumbar Spine ◽

Radiation Dose ◽

Radiation Protection ◽

Digital Radiography ◽

Patient Dose ◽

Obese Patients ◽

X Ray ◽

Whitney Test ◽

Mann Whitney Test ◽

Diagnostic Radiography

Abstract Dose audit is important towards optimisation of patients’ radiation protection in diagnostic radiography. In this study, the effect of the body mass index (BMI) on radiation dose received by 1869 adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis radiography in an X-ray room with a digital radiography system was investigated. Patients were categorised into three groups (normal, overweight and obese) based on the BMI values. The patients’ entrance surface air kerma (ESAK) and the effective dose (ED) were calculated based on the X-ray tube output, exposure parameters and technical data, as well as utilising appropriate conversion coefficients of the recorded kerma area product (KAP) values. The local diagnostic reference levels (LDRLs) were established at the 75th percentile of the distribution of ESAK and KAP values. Statistically, a significant increase was found in ESAK, KAP and ED values, for all examinations, both for overweight and obese patients compared to normal patients (Mann–Whitney test, p < 0.0001). Regarding the gender of the patients, a statistically significant increase was found in the dose values for male patients compared to female patients, except for the chest LAT examinations (Mann–Whitney test, p = 0.06). The percentage increase for chest PA, chest LAT, abdomen AP, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP in overweight patients was 75%, 100%, 136%, 130%, 70%, 66% and 174% for median ESAK, 67%, 81%, 135%, 134%, 85%, 63% and 172% for median KAP, as well as 89%, 54%, 146%, 138%, 82%, 57% and 183% for median ED values, respectively. For obese patients, the corresponding increases were 200%, 186%, 459%, 345%, 203%, 150% and 785% for median ESAK, 200%, 185%, 423%, 357%, 227%, 142% and 597% for median KAP, as well as 222%, 156%, 446%, 363%, 218%, 136% and 625% for median ED. The corresponding LDRLs for overweight patients were 0.17 mGy, 1.21 mGy, 3.74 mGy, 7.70 mGy, 7.99 mGy, 4.07mGy, 5.03 mGy and 0.13 Gy cm2, 0.69 Gy cm2, 2.35 Gy cm2, 2.10 Gy cm2, 2.59 Gy cm2, 2.13 Gy cm2, 2.49 Gy cm2 in terms of ESAK and KAP values, respectively, while in the case of obese patients were 0.28 mGy, 1.82 mGy, 7.26 mGy, 15.10 mGy, 13.86 mGy, 6.89 mGy, 13.40 mGy and 0.21 Gy cm2, 1.10 Gy cm2, 4.68 Gy cm2, 4.01 Gy cm2, 4.80 Gy cm2, 3.27 Gy cm2, 6.02 Gy cm2, respectively. It can be concluded that overweight and obese patients received a significantly increased radiation dose. Careful adjustment of imaging protocols is needed for these patients to reduce patient dose, while keeping the image quality at an acceptable level. Additional studies need to be conducted for these patient groups, that could further contribute to the development of radiation protection culture in diagnostic radiography.

Download Full-text

Determination of Radiation Dose from Routine X-ray Examination at Three Selected Hospitals in AlNajaf, Iraq

Iraqi Journal of Science ◽

10.24996/ijs.2019.60.10.9 ◽

2019 ◽

pp. 2163-2167

Author(s):

Hussien Abid Ali Bakir ◽

Talib Abdulridha Al-hchaimi ◽

Aymen S. Amran ◽

Aqeel H. Al Zurfi

Keyword(s):

Lumbar Spine ◽

Radiation Dose ◽

Biological Effects ◽

Skin Dose ◽

Hospital Data ◽

X Ray ◽

Exposure Factor ◽

Tube Potential ◽

Tube Current

People who undertaken different X-ray examinations are already exposed to ionizing radiation which causes biological effects. Therefore assessing the patient radiation dose is a prerequisite element in optimizing the X-ray practice and to avoid the unnecessary radiation dose. The aim of this research is to assess the skin radiation dose for those patients who undertaking routine X-ray examinations in selected three hospitals in Al Najaf city. Three X-ray units were involved in this experimental study; these were belonging to three hospitals in Al Najaf city-Iraq, namely Al-Sadder teaching hospital, Al-Hakeem general hospital and Al-Zahraa hospital. Data of exposure parameters (tube potential (kVp), tube current (mAs) and source to detector distance (d cm)). The data were collected from 160 patients exposed to radiation during different X-ray examinations. Patients were chosen to be within adult range (>18 years) and the selection was random (male and female). Patient skin dose was calculated mathematically using an established formula depending on the recorded exposure factor (kVp, mAs and d). Different X-ray examinations were considered, namely skull Posterior â€“anterior (PA), skull Lateral (LAT), chest PA, chest LAT, abdomen Anterior-posterior (AP), pelvis AP, lumbar spine AP and lumbar LAT. The average skin dose for all X-ray examinations considered in this research were as follow: 0.9, 0.76, 0.23, 0.41, 1.85, 1.82, 2.03 and 3.44 mGy, for skull PA, skull LAT, chest PA, chest LAT, abdomen AP, pelvis AP, lumbar spine(LS) AP and Lumbar spine (LS)LAT respectively. The results demonstrate that the dose values were comparable to those that were previously reported in published reference.

Download Full-text

LOW BMI PATIENT DOSE IN DIGITAL RADIOGRAPHY

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa007 ◽

2020 ◽

Vol 189 (1) ◽

pp. 1-12

Author(s):

Fotios O Efthymiou ◽

Vasileios I Metaxas ◽

Christos P Dimitroukas ◽

George S Panayiotakis

Keyword(s):

Lumbar Spine ◽

Radiation Dose ◽

Digital Radiography ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

X Ray ◽

Whitney Test ◽

Mann Whitney Test ◽

Significant Difference ◽

Low Bmi

Abstract In this study, the radiation dose received by 364 low body mass index (BMI) adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis X-ray examinations in an X-ray room with a digital radiography system was evaluated. The patients’ kerma area product (KAP) values were recorded, and the entrance surface air kerma (ESAK) was calculated based on the X-ray tube output, exposure parameters and technical data. The 75th percentiles of the distribution of ESAK and KAP values were also estimated. The dose values were compared with the corresponding values for normal patients obtained from a previous survey in our hospital, as well as with the national and UK diagnostic reference levels (DRLs). The correlation of dose values with patient size metrics (mass, height, BMI) was also investigated. A statistically significant difference was found in KAP and the ESAK values between low BMI and normal patients (Mann–Whitney test, p < 0.05), for all examinations studied. The percentage difference for chest PA, chest LAT, abdomen PA, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP examinations was 40, 36, 48, 68, 57, 46 and 67% for median KAP and 26, 43, 52, 48, 19, 44 and 51% for median ESAK, respectively. The corresponding 75th percentiles for low BMI patients were 0.065, 0.349, 0.683, 1.54, 3.92, 1.11, 0.67 mGy and 0.042, 0.218, 0.450, 0.280, 0.598, 0.597, 0.267 Gycm2 in terms of ESAK and KAP values, respectively. They were 74–90% lower compared to the national diagnostic reference levels (DRLs), 35–84% and 58–82% compared to the UK DRLs, for ESAK and KAP values, respectively. Regarding the gender of the patients, no statistically significant difference was found in the dose values between female and male patients (Mann–Whitney test, p > 0.05), for all examinations studied. A statistically significant correlation was found between ESAK and KAP values with BMI for KUB AP, pelvis AP, lumbar spine AP, lumbar spine LAT and chest PA, while for chest LAT examinations, only the ESAK were significantly correlated with BMI. They also significantly correlated with the mass for KUB AP, lumbar spine LAT, abdomen PA and chest PA examinations, while no significant correlation was found between the dose values and patients’ height. It can be concluded that the low BMI patients received a significantly reduced radiation dose compared to normal patients. Additional studies need to be conducted for these patient groups, which could contribute to the further development of a radiation protection culture in diagnostic radiography.

Download Full-text

JUSTIFICATION OF RADIOLOGICAL PROCEDURES ALGORITHM ADJUSTMENT IN DIAGNOSIS OF LOWER BACK PAIN CAUSE AT UNIVERSITY CLINICAL CENTER TUZLA

Acta Medica Saliniana ◽

10.5457/ams.v49i1.489 ◽

2019 ◽

Vol 49 (1) ◽

Author(s):

Aida Denjagić

Keyword(s):

Back Pain ◽

Lumbar Spine ◽

Radiation Dose ◽

Lower Back Pain ◽

Lower Back ◽

Clinical Center ◽

Spine Ct ◽

Diagnostic Key ◽

Magnetic Resonance Imaging Mri ◽

Radiological Procedures

Introduction: Lower Back Pain (LBP) is one of the most frequent reasons for visiting physican. Authors of guidelines scrutinizing use of radiography and Computed tomography (CT) or Magnetic resonance imaging (MRI) in LBP diagnostic. Method of choice in the LBP diagnostic should be MRI except in cases where we should get diagnostic informations as soon as possible (traumas etc.) and in strict indications in bone structures where CT should be a method of choice. Increase of CT use and following icrease CT derived radiation dose in patients are very serious problems of last decades. Aim: To show the nessesary of procedure algorithm adjusment in LBP diagnostic. Reasons are: danger of overdiagnosis leading to chronifications, loosing time and money to get exact diagnose and leading to cumulate very high ionizing doses (10 mSv per person with average body weight from lumbar spine CT) that could couse a cancer if it is over 100 mSv (in some studies if it is over 50 mSv). Patients and methods: Sixty-nine patients, average age of 51.35 years, were included in the study. Lumbar spine CT was performed and repeated procedure at MRI in a very short time in Clinic for Radiology and Nuclear Medicine of University Clinical Centre Tuzla from January 1 2017 to February 9 2018. The sample of patients was formed consecutively. Referral diagnosis for CT procedures were: M51 in 36 patients (52.17%), N/A in 13 (18.84%), M05 in 4 (5.8%), G83.4 in 3 (4.35%) and other in 13 (18.84%). Results: 30 (83.33%) of patients were referred from CT to MRI procedure in time under 42 days (during acute phase). Relation of justified and unjustified undertaken CT procedures were: 71% unjustified, 10% justified and 19% N/A.Conclusion: Performed study showed unjustified undertaken CT procedures and high unnecessary radiation dose in 71% patients. There are justified reasons for procedure algorithm adjusment in LBP diagnostic. Key words: lower back pain, diagnostic procedure algorithm, CT, MRI

Download Full-text