Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK.
Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
Radiography (Lond). 2023 Jul;29(4):690-696. doi: 10.1016/j.radi.2023.04.013. Epub 2023 May 13.
Lumbar radiographs remain a common imaging examination despite strategies to reduce their use. Many authors have demonstrated benefits in changing from traditional supine and recumbent lateral projections to a prone and/or erect orientation. Despite evidence of clinical and radiation dose optimisation, widespread adoption of these strategies has stalled. This article describes the single-centre implementation and evaluation of erect PA and lateral projections.
This was an observational study pre- and post-implementation of an erect imaging protocol. Patient BMI, image field size, source image and source object distances and DAP were collected together with assessment of radiographic spinal alignment and disc space demonstration. Effective dose was calculated with organ specific doses.
76 (53.5%) patients were imaged in the supine AP and recumbent lateral position, 66 (46.5%) had erect PA and lateral radiographs. Despite the larger BMI of the erect cohort and similar field sizes, effective dose was lower in the PA position by an average of 20% (p < 0.05), however, no significant difference in lateral dose. Anatomical improvements were evident with greater visualisation of intervertebral disc spaces in the PA erect (t = -9.03; p < .001) and lateral (t = -10.298; p < .001) orientations. Erect PA radiographs demonstrated a leg length discrepancy in 47.0% (0.3-4.7 cm) and a scoliosis in 21.2% of cases, with a significant link between these findings (r (64) = 0.44; p < .001).
Erect lumbar spine radiography provides information on clinical outcomes not available with recumbent projections. The improvements in anatomical visualisation and radiation dose reduction supports the local change in practice.
尽管有减少使用的策略，腰椎 X 光片仍然是一种常见的影像学检查。许多作者已经证明，从传统的仰卧和侧卧侧位改为俯卧和/或直立位会带来益处。尽管有临床和辐射剂量优化的证据，但这些策略的广泛采用已经停滞不前。本文描述了在单一中心实施和评估直立前后位和侧位投影。
这是一项前瞻性研究，在实施直立成像方案前后进行。收集患者 BMI、图像野大小、源图像和源物体距离以及 DAP，同时评估放射学脊柱排列和椎间盘间隙显示。使用器官特异性剂量计算有效剂量。
76 例（53.5%）患者行仰卧前后位和侧卧位 X 光检查，66 例（46.5%）行直立前后位和侧位 X 光检查。尽管直立组的 BMI 较大且野大小相似，但 PA 位的有效剂量平均降低 20%（p<0.05），而侧位剂量无显著差异。在 PA 直立位（t=-9.03；p<.001）和侧位（t=-10.298；p<.001）中，椎间盘间隙的可视化得到了明显改善。47.0%（0.3-4.7cm）的直立 PA 位 X 光片显示下肢长度差异，21.2%的病例显示脊柱侧凸，这些发现之间存在显著关联（r（64）=0.44；p<.001）。
直立腰椎 X 光摄影提供了仰卧位投影无法提供的临床结果信息。解剖学可视化的改善和辐射剂量的降低支持了当地实践的改变。
