青少年特发性脊柱侧弯患者全脊柱 X 射线检查中使用铜滤器的剂量减少方案。
Dose Reduction Protocol for Full Spine X-ray Examination Using Copper Filters in Patients With Adolescent Idiopathic Scoliosis.
机构信息
Department of Radiological Technology, Kanazawa University Hospital, Kanazawa, Japan.
Department of Orthopedics, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
出版信息
Spine (Phila Pa 1976). 2019 Feb 1;44(3):203-210. doi: 10.1097/BRS.0000000000002787.
STUDY DESIGN
A prospective case series.
OBJECTIVE
The aim of this study was to assess a new protocol for full spine X-ray using copper (Cu) filters to reduce radiation exposure in patients with adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA
Radiation exposure is associated with an increased risk of cancer development in children. To reduce the radiation exposure without compromising the image quality using existing radiographic equipment, a new computed radiography protocol was optimized using a variety of heavy metal filters.
METHODS
Study 1: Whole spine radiographs were obtained using a human body phantom, and radiation doses without and with 0.1, 0.2, and 0.3 mm thick Cu filters were compared. Study 2: Patients with AIS who underwent posterior fusion were radiographically evaluated at follow-ups; the X-ray protocols with or without the use of 0.2-mm Cu filters were alternated between consecutive follow-ups. The image quality was independently evaluated using six points in the anterior-posterior (AP) view and seven in the lateral [left-right (LR)] view by three spine surgeons using a three-point grading system.
RESULTS
Study 1: The surface doses while obtaining nonfiltered X-rays in AP and LR views were 0.31 and 0.93 mGy, respectively, whereas those with 0.1-, 0.2-, and 0.3-mm Cu filters were 0.16 and 0.52, 0.11 and 0.36, and 0.08 and 0.27 mGy, respectively.Study 2: In patients with AIS, the percentage of grade 3 scores (both endplates were identifiable) on AP-view images was 85% with nonfiltered X-rays and 75% with the filtered X-rays. However, there were no significant differences between the two protocols. On LR images, the frequency of grade 3 scores was significantly lower at Th2 and Th12 on filtered images than on nonfiltered ones.
CONCLUSION
Whole spine radiographs using 0.2-mm Cu filters in patients with AIS could reduce radiation exposure more than 60% while preserving the image quality.
LEVEL OF EVIDENCE
研究设计
前瞻性病例系列研究。
目的
本研究旨在评估一种新的脊柱全长 X 射线摄影方案，使用铜（Cu）滤片减少青少年特发性脊柱侧凸（AIS）患者的辐射暴露。
背景资料概要
辐射暴露与儿童癌症发病风险增加相关。为了在不影响图像质量的情况下，利用现有的 X 射线设备降低辐射暴露，我们使用各种重金属滤片优化了一种新的计算机射线摄影方案。
方法
研究 1：使用人体模型获得脊柱全长 X 射线照片，比较无滤片和 0.1、0.2 和 0.3mm 厚的 Cu 滤片时的辐射剂量。研究 2：接受后路融合的 AIS 患者在随访时进行影像学评估；在连续随访中交替使用或不使用 0.2mm Cu 滤片的 X 射线方案。三名脊柱外科医生使用三分制评分系统，在前后位（AP）视图中评估 6 个点，在侧位（LR）视图中评估 7 个点，对图像质量进行独立评估。
结果
研究 1：在 AP 和 LR 视图中，获得无滤片 X 射线时的表面剂量分别为 0.31 和 0.93mGy，而使用 0.1、0.2 和 0.3mm Cu 滤片时，分别为 0.16 和 0.52、0.11 和 0.36、0.08 和 0.27mGy。研究 2：在 AIS 患者中，AP 视图图像中 grade 3 评分（两个终板均能识别）的百分比为无滤片 X 射线组 85%，滤片 X 射线组 75%。然而，两种方案之间没有显著差异。在 LR 图像上，滤片图像上 Th2 和 Th12 的 grade 3 评分频率明显低于无滤片图像。
结论
在 AIS 患者中使用 0.2mm Cu 滤片进行脊柱全长 X 射线摄影可以将辐射暴露降低 60%以上，同时保持图像质量。
证据水平
4 级。
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