Practice and Perception of Radiographers on the Positioning Techniques of Erect Lateral Cervical Spine Radiography in Non-trauma Adult Patients

Background: The visualization of the lower cervical spine (C-spine), including the C7-T1 junction on lateral radiograph is a challenge due to the overlapping of the shoulder girdle. Therefore, the radiographers have adapted different positioning strategies to overcome this challenge. This study explores the current practice and perception of radiographers on positioning techniques of erect lateral cervical spine radiography in non-trauma adult patients. Methods: This prospective study was conducted with a self-administered, structured questionnaire distributed among 50 radiographers working in four selected hospitals in Sri Lanka. Results: The radiographers used weight-bearing and non-weight-bearing positioning techniques for the erect lateral C-spine radiography. Most of them employed the standing breath-holding technique for image acquisition with or without exertion. While 54% of the radiographers utilized two water-filled cans during the weight-bearing technique, 82% used holding arms back with the shoulders down and pulling as low as possible in the non-weight-bearing technique. In addition, 88% of the radiographers believed that the weight-bearing position could increase the visibility of the C-spine. Almost all the radiographers (100%) stated that correct positioning instruction could improve the visibility of the C-spine. Conclusion: Radiographers have mainly used two positioning techniques of weight-bearing and non-weight-bearing for erect lateral C-spine radiography for non-trauma adult patients. In addition, most radiographers had a positive attitude toward the weight-bearing technique in the evaluation of lateral C-spine. These results highlight the importance of conducting studies to evaluate the effectiveness of the weight-bearing technique in erect lateral C-spine radiography.

ANODE HEEL EFFECT ATTENUATION IN LUMBAR SPINE RADIOGRAPHY: CAN THE USE OF ALUMINIUM FILTERS IMPROVE CLINICAL PRACTICE OF RADIOGRAPHERS?

Purpose: The aim of this study was to design an aluminium-based filter to reduce the anode heel effect in lumbar spine radiographs. Methods: Initially, lumbar spine examinations were observed in a public imaging department to determine the standard exposure parameters. Then, the characterization of the anode heel effect was made using the Unfors Xi R/F detector and based on the data collected, aluminium filters were designed with a wedge shape, with thicknesses ranging from 0.1 to 4.0 mm. The assessment of the entrance skin dose (ESD) reduction was performed on the anthropomorphic phantom, with and without filters, using the universal dosimeter UNIDOS E equipped with an ionization chamber. Lastly, the image quality assessment was performed with the Pehamed Phantom Digrad A+K and image quality surveys were applied to radiographers and radiologists. Results and Discussion: Uniformity of the beam was achieved, especially with the filter number 2, which presents a significant variation of 9% between cathode and anode side. This filter contributes to ESD reduction of 35% and 36% for AP and lateral projection, respectively. Also, according to the radiographers and radiologists, it improves the image quality of lumbar spine radiography. Conclusion: The use of aluminium filters can be advantageous in the clinical practice of radiographers when carrying out lumbar spine radiographs, since it allows to standardize the anode heel effect, reducing the radiation dose to the patient and without compromising the image quality.

Anterior Pelvic Plane: A Potentially Useful Pelvic Anatomical Reference Plane in Assessing the Patients’ Ideal Pelvic Parameters Without the Influence of Spinal Sagittal Deformity

Study Design: Observational study. Objective: This study was aimed at investigating the reliability of anterior pelvic plane (APP) as an anatomical reference plane for assessing the patients’ pelvic incidence in patients with ankylosing spondylitis kyphosis deformity. Methods: The globe kyphosis (GK), lumber lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), anatomical cervical 7 sacrum angle (aC7SA), and cervical 7 sacrum angle (C7SA) were measured on full-length spine radiography imagines. The pelvic incidence (PI), anatomical pelvic tilt (aPT), and anatomical sacral slope (aSS) were measured on the pelvic synthesized 2D lateral radiography imagines. Because the angle between APP and vertical line was about 4°, Angle1 and tPT were calculated using the following formulas: Angle1 = aC7SA − 4; PT = aPT + 4. According to the study conducted by Vialle, traditional PT (tPT) was calculated using the following widely accepted formula: tPT = PI * 0.37 − 7. Measured PT (mPT) was also measured on the full-length spine radiography imagines. Results: The data analysis showed that PI, mPT, aSS, aPT, and APPA were 50.83 ± 13.44°, 32.52 ± 4.64°, 41.36 ± 9.46°, 8.56 ± 6.80°, and 23.95 ± 5.17°, respectively. There was no significant difference between the PT and tPT (12.56 ± 6.80, 11.49 ± 4.73; P = .152). So, the results demonstrated that the PT could play the equivalent effect as tPT did for making surgical plans in patients with kyphosis deformity. Conclusion: The pelvic anatomical reference plane had potential to be used in assessing the patients’ ideal pelvic incident without the influence of spinal sagittal deformity. The aPT+4 may represent patients’ postoperative ideal PT.