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ECR 2019 / C-3552
May we Further Reduce Dose in the Assessment of Full Spine Radiography in Children?
Congress: ECR 2019
Poster No.: C-3552
Type: Scientific Exhibit
Keywords: Image verification, Dosimetric comparison, Radiation safety, Dosimetry, Diagnostic procedure, Digital radiography, Radioprotection / Radiation dose, Paediatric, Musculoskeletal spine
Authors: J. Piqueras, J. C. Carreño, C. García Fontecha, A. M. VIVEROS CASTAÑO, M. A. Rios Vives, A. catala; Barcelona/ES

Aims and objectives

Scoliosis diagnosis and follow-up requires many full spine x-ray examinations performed along the late childhood and adolescence periods, even quarterly along their puberal growth peak. Retrospective population studies raised solid concerns that patients with scoliosis suffer an increased risk of breast cancer along their adult lives, related to their prior breast x-ray exposures. The risk of radiation-related breast cancer is higher for patients having female blood relatives with breast cancer than those who did not report such family history [1, 2]. Therefore, different strategies to reduce radiation exposure for full spine radiography are encouraged in all patients. Reduction of the radiation dose is readily achievable in all digital modalities by simply reducing radiographic technical parameters, causing a relative underexposure of the obtained images [3-6].  

As a measure to further reduce breast X-ray exposure, full-spine postero-anterior x-ray projections are recommended, avoiding the higher direct entrance dose, and allowing a breast dose up to 1:5 of entrance dose. But this position, with the spine not contacting the x-ray detector, adds geometric blur. 

These reduced dose images convey quantum mottle, increased blur, causing a relative reduction in the sharpness and contrast of bone landmarks, that may hamper quantitative and pattern assessment [3-6], as of Cobb's angle measurement and Risser's maturation grading, already known as challenging for reproducibility [7-11].


This work compares two full spine digital radiography protocols, one low dose protocol and one standard dose, if applied for scoliosis assessment: focusing in the reproducibility of Cobb's angle and Risser grading, between an optimized protocol for full spine radiography.

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