A systematic procedure to optimise dose and image quality for the measurement of inter-vertebral angles from lateral spinal projections using Cobb and superimposition methods.

BACKGROUND Patients with vertebral column deformations are exposed to high risks associated with ionising radiation exposure. Risks are further increased due to the serial X-ray images that are needed to measure and asses their spinal deformation using Cobb or superimposition methods. Therefore, optimising such X-ray practice, via reducing dose whilst maintaining image quality, is a necessity. OBJECTIVES With a specific focus on lateral thoraco-lumbar images for Cobb and superimposition measurements, this paper outlines a systematic procedure to the optimisation of X-ray practice. METHODS Optimisation was conducted based on suitable image quality from minimal dose. Image quality was appraised using a visual-analogue-rating-scale, and Monte-Carlo modelling was used for dose estimation. The optimised X-ray practice was identified by imaging healthy normal-weight male adult living human volunteers. RESULTS The optimised practice consisted of: anode towards the head, broad focus, no OID or grid, 80 kVp, 32 mAs and 130 cm SID. CONCLUSION Images of suitable quality for laterally assessing spinal conditions using Cobb or superimposition measurements were produced from an effective dose of 0.05 mSv, which is 83% less than the average effective dose used in the UK for lateral thoracic/lumbar exposures. This optimisation procedure can be adopted and use for optimisation of other radiographic techniques.