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Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Radiology. (Radiologi)ORCID iD: 0000-0003-0137-9991
Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden.ORCID iD: 0000-0003-0529-7723
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Physics.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Radiology. (Radiologi)
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 5, 602-611 p.Article in journal (Refereed) Published
Abstract [en]

Background: Lumbar spine radiography is often performed instead of CT for radiation dose concerns.

Purpose: To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography.

Material and Methods: Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes.

Results: Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv.

Conclusion: Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2016. Vol. 57, no 5, 602-611 p.
Keyword [en]
Radiation dose, radiography, tomography, X-ray computed, axial skeleton
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:oru:diva-47090DOI: 10.1177/0284185115595667ISI: 000374327600014PubMedID: 26221055OAI: oai:DiVA.org:oru-47090DiVA: diva2:883135
Available from: 2015-12-16 Created: 2015-12-16 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)
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Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2017-10-17Bibliographically approved

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Alshamari, MuhammedGeijer, MatsNorrman, EvaLidén, MatsKrauss, WolfgangGeijer, Håkan
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