ST4 Radiology Registrar, Musgrove Park Hospital, Taunton, United Kingdom.
Consultant Musculoskeletal Radiologist, Musgrove Park Hospital, Taunton, United Kingdom.
Br J Radiol. 2019 Nov;92(1103):20190386. doi: 10.1259/bjr.20190386. Epub 2019 Aug 7.
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.
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 MannWhitney tests and linear regression. Eighty radiologists nationally were sent an anonymous survey to establish their current practice.
A lumbar spine radiograph acquired PA instead of AP reduced effective dose by 41% ( < 0.001) with no difference in image quality ( = 0.9). 21 radiologists completed our survey and only 1 NHS Trust is currently using PA.
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.
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.
体模研究和先前的患者研究表明，与前后位（AP）相比，后前位（PA）获取腰椎 X 光片可有效降低 53%的剂量。自 2017 年 11 月起，萨默塞特郡国民保健署（Taunton and Somerset NHS Foundation Trust）开始采用 PA 位获取所有站立位腰椎 X 光片。本研究旨在对两种投照体位的剂量和图像质量进行局部评估，并调查当前英国的实际情况。
80 名门诊患者接受站立位腰椎 X 光检查（40 例 AP 位；40 例 PA 位），在恒定的千伏值和焦点胶片距离下记录剂量面积乘积。使用 PCXMC 软件计算有效剂量。使用欧洲指南标准对每幅 X 光片进行盲法评估，与最佳参考图像进行比较。采用 Mann-Whitney U 检验和线性回归对数据进行分析。向全国 80 名放射科医生发送匿名调查问卷，以了解其当前的实践情况。
与 AP 位相比，PA 位腰椎 X 光片可使有效剂量降低 41%（<0.001），但图像质量无差异（=0.9）。21 名放射科医生完成了我们的调查，只有 1 家国民保健署信托基金目前在使用 PA 位。
PA 位腰椎 X 光摄影可降低患者的辐射暴露，同时不影响图像质量、采集时间或成本。全国大多数国民保健署信托基金仍在使用 AP 位，现在是时候将其标准化为 PA 位了。
本患者研究进一步提供了充分的证据，证明如何在腰椎 X 光摄影中降低辐射暴露，更广泛地采用 PA 方案可能会提高患者安全性。
