Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go?

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2017 Dec 23

PMID 29269403

Citations 6

Authors

M Tozakidou

C Reisinger

D Harder

J Lieb

Z Szucs-Farkas

M Muller-Gerbl

U Studler

S Schindera

A Hirschmann

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: While the use of cervical spine CT in trauma settings has increased, the balance between image quality and dose reduction remains a concern. The purpose of our study was to compare the image quality of CT of the cervical spine of cadaveric specimens at different radiation dose levels.

Materials And Methods: The cervical spine of 4 human cadavers (mean body mass index; 30.5 ± 5.2 kg/m; range, 24-36 kg/m) was examined using different reference tube current-time products (45, 75, 105, 135, 150, 165, 195, 275, 355 mAs) and a tube voltage of 120 kV(peak). Data were reconstructed with filtered back-projection and iterative reconstruction. Qualitative image noise and morphologic characteristics of bony structures were quantified on a Likert scale. Quantitative image noise was measured. Statistics included analysis of variance and the Tukey test.

Results: Compared with filtered back-projection, iterative reconstruction provided significantly lower qualitative (mean noise score: iterative reconstruction = 2.10/filtered back-projection = 2.18; = .003) and quantitative (mean SD of Hounsfield units in air: iterative reconstruction = 30.2/filtered back-projection = 51.8; < .001) image noise. Image noise increased as the radiation dose decreased. Qualitative image noise at levels C1-4 was rated as either "no noise" or as "acceptable noise." Any shoulder position was at level C5 and caused more artifacts at lower levels. When we analyzed all spinal levels, scores for morphologic characteristics revealed no significant differences between 105 and 355 mAs ( = .555), but they were worse in scans at 75 mAs ( = .025).

Conclusions: Clinically acceptable image quality of cervical spine CTs for evaluation of bony structures of cadaveric specimens with different body habitus can be achieved with a reference mAs of 105 at 120 kVp with iterative reconstruction. Pull-down of shoulders during acquisition could improve image quality but may not be feasible in trauma patients with unknown injuries.

Citing Articles

Geometric accuracy of low-dose CT scans for use in shoulder musculoskeletal research applications.

Lawrence R, Nicholson L, Lee E, Napier K, Zmistowski B, Rainbow M Med Eng Phys. 2024; 130:104214.

PMID: 39160033 PMC: 11479651. DOI: 10.1016/j.medengphy.2024.104214.

Influence of helical pitch and gantry rotation time on image quality and file size in ultrahigh-resolution photon-counting detector CT.

Feldle P, Grunz J, Huflage H, Kunz A, Ergun S, Afat S Sci Rep. 2024; 14(1):9358.

PMID: 38653758 PMC: 11039754. DOI: 10.1038/s41598-024-59729-6.

Deep learning-driven diagnosis of multi-type vertebra diseases based on computed tomography images.

Wang Y, Su F, Lu Q, Zhang W, Liu T, Tao Y Quant Imaging Med Surg. 2024; 14(1):800-813.

PMID: 38223021 PMC: 10784083. DOI: 10.21037/qims-23-685.

Is It Possible to Replace Conventional Radiography (CR) with a Dose Neutral Computed Tomography (CT) of the Cervical Spine in Emergency Radiology-An Experimental Cadaver Study.

Deak Z, Brummund L, Kirchhoff S, Korner M, Geyer L, Muck F Diagnostics (Basel). 2022; 12(8).

PMID: 36010222 PMC: 9406668. DOI: 10.3390/diagnostics12081872.

Ultra-low-dose CT versus radiographs for minor spine and pelvis trauma: a Bayesian analysis of accuracy.

Hamard A, Greffier J, Bastide S, Larbi A, Addala T, Sadate A Eur Radiol. 2020; 31(4):2621-2633.

PMID: 33034747 DOI: 10.1007/s00330-020-07304-8.

References

Hoang J, Yoshizumi T, Nguyen G, Toncheva G, Roy Choudhury K, Gafton A . Variation in tube voltage for adult neck MDCT: effect on radiation dose and image quality. AJR Am J Roentgenol. 2012; 198(3):621-7. DOI: 10.2214/AJR.11.6831. View

Wirth S, Meindl T, Treitl M, Pfeifer K, Reiser M . Comparison of different patient positioning strategies to minimize shoulder girdle artifacts in head and neck CT. Eur Radiol. 2006; 16(8):1757-62. DOI: 10.1007/s00330-006-0168-7. View

Pan X, Sidky E, Vannier M . Why do commercial CT scanners still employ traditional, filtered back-projection for image reconstruction?. Inverse Probl. 2011; 25(12):1230009. PMC: 2849113. DOI: 10.1088/0266-5611/25/12/123009. View

Schindera S, Diedrichsen L, Muller H, Rusch O, Marin D, Schmidt B . Iterative reconstruction algorithm for abdominal multidetector CT at different tube voltages: assessment of diagnostic accuracy, image quality, and radiation dose in a phantom study. Radiology. 2011; 260(2):454-62. DOI: 10.1148/radiol.11102217. View

Winklehner A, Karlo C, Puippe G, Schmidt B, Flohr T, Goetti R . Raw data-based iterative reconstruction in body CTA: evaluation of radiation dose saving potential. Eur Radiol. 2011; 21(12):2521-6. DOI: 10.1007/s00330-011-2227-y. View

Becce F, Ben Salah Y, Verdun F, Vande Berg B, Lecouvet F, Meuli R . Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low-dose protocol using filtered back-projection and iterative reconstruction. Skeletal Radiol. 2013; 42(7):937-45. DOI: 10.1007/s00256-013-1576-9. View

Gnannt R, Winklehner A, Goetti R, Schmidt B, Kollias S, Alkadhi H . Low kilovoltage CT of the neck with 70 kVp: comparison with a standard protocol. AJNR Am J Neuroradiol. 2012; 33(6):1014-9. PMC: 8013269. DOI: 10.3174/ajnr.A2910. View

Mower W, Hoffman J, Pollack Jr C, Zucker M, Browne B, Wolfson A . Use of plain radiography to screen for cervical spine injuries. Ann Emerg Med. 2001; 38(1):1-7. DOI: 10.1067/mem.2001.115946. View

Mulkens T, Marchal P, Daineffe S, Salgado R, Bellinck P, te Rijdt B . Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma. AJNR Am J Neuroradiol. 2007; 28(8):1444-50. PMC: 8134402. DOI: 10.3174/ajnr.A0608. View

10.

Jaju A, Shaw H, Don S, Bowling R, Hildebolt C . ALARA: Impact of Practice Quality Improvement Initiative on Dose Reduction in Pediatric Voiding Cystourethrogram. AJR Am J Roentgenol. 2015; 205(4):886-93. DOI: 10.2214/AJR.14.13492. View

11.

Kranz P, Wylie J, Hoang J, Kosinski A . Effect of the CT table strap on radiation exposure and image quality during cervical spine CT. AJNR Am J Neuroradiol. 2014; 35(10):1870-6. PMC: 7966249. DOI: 10.3174/ajnr.A4074. View

12.

Acheson M, Livingston R, Richardson M, Stimac G . High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations. AJR Am J Roentgenol. 1987; 148(6):1179-85. DOI: 10.2214/ajr.148.6.1179. View

13.

Saketkhoo D, Bhargavan M, Sunshine J, Forman H . Emergency department image interpretation services at private community hospitals. Radiology. 2004; 231(1):190-7. DOI: 10.1148/radiol.2311030307. View

14.

Moscariello A, Takx R, Schoepf U, Renker M, Zwerner P, OBrien T . Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection. Eur Radiol. 2011; 21(10):2130-8. DOI: 10.1007/s00330-011-2164-9. View

15.

Fonseca A, Cherubini K, Veeck E, Ladeira R, Carapeto L . Effect of 10% formalin on radiographic optical density of bone specimens. Dentomaxillofac Radiol. 2008; 37(3):137-41. DOI: 10.1259/dmfr/18109064. View

16.

Deak P, Smal Y, Kalender W . Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology. 2010; 257(1):158-66. DOI: 10.1148/radiol.10100047. View

17.

Woodring J, Lee C . Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma. 1993; 34(1):32-9. DOI: 10.1097/00005373-199301000-00006. View

18.

Daffner R, Hackney D . ACR Appropriateness Criteria on suspected spine trauma. J Am Coll Radiol. 2007; 4(11):762-75. DOI: 10.1016/j.jacr.2007.08.006. View

19.

Gleeson T, Byrne B, Kenny P, Last J, Fitzpatrick P, OGorman P . Image quality in low-dose multidetector computed tomography: a pilot study to assess feasibility and dose optimization in whole-body bone imaging. Can Assoc Radiol J. 2010; 61(5):258-64. DOI: 10.1016/j.carj.2010.01.003. View

20.

Willemink M, Leiner T, de Jong P, de Heer L, Nievelstein R, Schilham A . Iterative reconstruction techniques for computed tomography part 2: initial results in dose reduction and image quality. Eur Radiol. 2013; 23(6):1632-42. DOI: 10.1007/s00330-012-2764-z. View