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Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Radiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-0137-9991
Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden.
Örebro University Hospital.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Radiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3253-8967
2014 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 55, no 7, 824-832 p.Article in journal (Refereed) Published
Abstract [en]

Background: Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv.

Purpose: To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible.

Material and Methods: An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured.

Results: A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography.

Conclusion: Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.

Place, publisher, year, edition, pages
2014. Vol. 55, no 7, 824-832 p.
Keyword [en]
conventional radiography; CT; spine; structures; techniques
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:oru:diva-38243DOI: 10.1177/0284185113509615ISI: 000342575300008Scopus ID: 2-s2.0-84907878366OAI: oai:DiVA.org:oru-38243DiVA: diva2:760077
Available from: 2014-11-03 Created: 2014-10-30 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Low-dose computed tomography of the abdomen and lumbar spine
Open this publication in new window or tab >>Low-dose computed tomography of the abdomen and lumbar spine
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 87 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 137
Keyword
Tomography, X-Ray Computed, Radiography, Radiation Dosage, Abdomen, Spine, Lumbosacral Region, Regression Analysis
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-48242 (URN)978-91-7529-104-8 (ISBN)
Public defence
2016-04-08, Universitetssjukhuset, Bohmanssonsalen, Södra Grev Rosengatan, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2017-10-17Bibliographically approved

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