A study on diagnostic value of oblique lumbar spine radiographs

Abstract Dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool are recommended tools for osteoporotic fracture risk evaluation, but are underutilized. We present a novel and fully-automated tool to identify fractures, predict bone mineral density (BMD), and evaluate fracture risk using plain pelvis and lumbar spine radiographs. The performance of this tool were evaluated in 1639 and 11908 patients with pelvis or lumbar spine radiographs and DXA, respectively. The model was well calibrated for hip and spine BMD assessments with minimal or no bias. The area under the curve and accuracy were 0.89 and 92.4% for hip osteoporosis, 0.87 and 86.8% for spine osteoporosis, 0.92 and 94.6% for high 10-year major fracture risk, and 0.92 and 92.2% for high hip fracture risk, respectively. The success rates of our automated algorithm a real-world test were 85.3% and 90.4% for hip and spine, respectively. The clinical use of this automated tool may increase the likelihood of identifying high-risk patients in previously unscreened populations.

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The Radiation Exposure Associated With Cervical and Lumbar Spine Radiographs

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3181568656 ◽

2008 ◽

Vol 21 (6) ◽

pp. 409-412 ◽

Cited By ~ 42

Author(s):

Andrew K. Simpson ◽

Peter G. Whang ◽

Ari Jonisch ◽

Andrew Haims ◽

Jonathan N. Grauer

Keyword(s):

Lumbar Spine ◽

Radiation Exposure ◽

Spine Radiographs

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

Radiography ◽

10.1016/j.radi.2014.03.010 ◽

2014 ◽

Vol 20 (3) ◽

pp. 251-257 ◽

Cited By ~ 7

Author(s):

F.E. Mellor ◽

P. Thomas ◽

A. Breen

Keyword(s):

Lumbar Spine ◽

Radiation Dose ◽

Dose Reduction ◽

Spine Radiographs

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Lumbar spine radiographs — is it time for widespread adoption of posteroanterior projection?

British Journal of Radiology ◽

10.1259/bjr.20190386 ◽

2019 ◽

Vol 92 (1103) ◽

pp. 20190386

Author(s):

Christopher Green ◽

Guru Karnati ◽

Katharine Thomson ◽

Ashok Subramanian

Keyword(s):

Lumbar Spine ◽

Image Quality ◽

Effective Dose ◽

Acquisition Time ◽

Reference Image ◽

Patient Study ◽

Spine Radiography ◽

Widespread Adoption ◽

Spine Radiograph ◽

Spine Radiographs

Objective: Phantom studies and a prior patient study have shown up to 53% effective dose reduction when lumbar spine radiographs are acquired posteroanterior (PA) instead of anteroposterior (AP). Since November 2017, Taunton and Somerset NHS Foundation Trust has acquired all standing lumbar spine radiographs PA. The aim of this study was to locally evaluate dose and image quality in both projections and survey current UK practice. Methods: 80 outpatients having a standing lumbar spine radiograph (40 AP; 40 PA) had their dose–area product recorded at a constant KV and focus film distance. Effective dose was calculated using PCXMC software. Each blinded radiograph was scored against an optimal reference image using European Guidelines criteria. The data were analyzed using Mann–Whitney U tests and linear regression. Eighty radiologists nationally were sent an anonymous survey to establish their current practice. Results: A lumbar spine radiograph acquired PA instead of AP reduced effective dose by 41% (p < 0.001) with no difference in image quality (p = 0.9). 21 radiologists completed our survey and only 1 NHS Trust is currently using PA. Conclusion: PA lumbar spine radiography reduces patient radiation exposure with no affect on image quality, acquisition time or cost. The majority of NHS Trusts nationally are still using AP and it is time to standardize to PA. Advances in knowledge: This patient study provides further good evidence of how reduction in exposure to ionizing radiation can be achieved in lumbar spine radiography and more widespread adoption of PA protocol could improve patient safety.

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