<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2018-0021_s_000_w2aab3b7b1b1b6b1aab1c18b1Aa"><h3>Background</h3><p>The aim of the study was to compare patient radiation dose and image quality in planar lumbar spine radiography using the PA and AP projection in a large variety of patients of both sexes and different sizes.</p></sec><sec id="j_raon-2018-0021_s_006_w2aab3b7b1b1b6b1aab1c18b2Aa"><h3>Patients and methods</h3><p>In the first phase data of image field size, DAP, effective dose and image quality were gathered for AP and PA projection in lumbar spine imaging of anthropomorphic phantom. In the second phase, data of BMI, image field size, diameter of the patient’s abdomen, DAP, effective dose and image quality were gathered for 100 patients of both sexes who were referred to lumbar spine radiography. The patients were divided into two groups of 50 patients, one of which was imaged using the AP projection while the other the PA projection.</p></sec><sec id="j_raon-2018-0021_s_007_w2aab3b7b1b1b6b1aab1c18b3Aa"><h3>Results</h3><p>The study on the phantom showed no statistically significant difference in image field size, DAP and image quality. However, the calculated effective dose in the PA projection was 25% lower compared to AP projection (p =0.008). Measurements on the patients showed no statistically significant difference between the BMI and the image field size. In the PA projection, the thickness of abdomen was 10% (p &lt; 10<sup>–3</sup>) lower, DAP 27% lower (p = 0.009) and the effective dose 53% (p &lt; 10<sup>–3</sup>) lower than in AP projection. There was no statistically significant difference in image quality between the AP and the PA projection.</p></sec><sec id="j_raon-2018-0021_s_008_w2aab3b7b1b1b6b1aab1c18b4Aa"><h3>Conclusions</h3><p>The study results support the use of the PA projection as the preferred method of choice in planar lumbar spine radiography.</p></sec></abstract>

BackgroundThe aim of the study was to compare patient radiation dose and image quality in planar lumbar spine radiography using the PA and AP projection in a large variety of patients of both sexes and different sizes.Patients and methodsIn the first phase data of image field size, DAP, effective dose and image quality were gathered for AP and PA projection in lumbar spine imaging of anthropomorphic phantom. In the second phase, data of BMI, image field size, diameter of the patient’s abdomen, DAP, effective dose and image quality were gathered for 100 patients of both sexes who were referred to lumbar spine radiography. The patients were divided into two groups of 50 patients, one of which was imaged using the AP projection while the other the PA projection.ResultsThe study on the phantom showed no statistically significant difference in image field size, DAP and image quality. However, the calculated effective dose in the PA projection was 25% lower compared to AP projection (p =0.008). Measurements on the patients showed no statistically significant difference between the BMI and the image field size. In the PA projection, the thickness of abdomen was 10% (p < 10–3) lower, DAP 27% lower (p = 0.009) and the effective dose 53% (p < 10–3) lower than in AP projection. There was no statistically significant difference in image quality between the AP and the PA projection.ConclusionsThe study results support the use of the PA projection as the preferred method of choice in planar lumbar spine radiography.

Comparison of anteroposterior and posteroanterior projection in lumbar spine radiography

Medical Imaging and Radiotherapy Department

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundThe aim of the study was to compare patient radiation dose and image quality in planar lumbar spine radiography using the PA and AP projection in a...

Variable	Projection	Mean	Standard deviation	Median	Minimum	Maximum
Body mass index	AP	26.6	3.2	26.3	19.7	35.2
Body mass index	PA	26.6	4.0	26.6	20.0	35.7
Imaging field size (cm²)	AP	822.8	62.2	832.5	653.4	992.0
Imaging field size (cm²)	PA	830.8	65.4	848.4	630.9	941.1
Patient’s abdominal diameter (cm)	AP	23.6	4.0	24.0	16.0	30.0
Patient’s abdominal diameter (cm)	PA	21.2	2.8	22.0	15.5	28.0
Dose-area product μGy m²)	AP	61.0	30.9	55.4	21.6	137.6
Dose-area product μGy m²)	PA	44.7	19.8	41.4	15.3	94.5
Effective dose (μSv)	AP	169	72	159	55	346
Effective dose (μSv)	PA	79	24	77	45	136
Average image estimation	AP	27.4	1.5	27.9	23.3	29.7
Average image estimation	PA	27.5	1.4	28	24.7	29.7

Variable	Projection	Mean	Standard deviation	Median	Minimum	Maximum
Imaging field size (cm²)	AP	725.5	120.0	690.1	587.4	913.5
Imaging field size (cm²)	PA	788.1	66.2	770.3	723.6	874.5
Dose-area product (μGy m²)	AP	26.7	3.6	25.9	22.4	32.1
Dose-area product (μGy m²)	PA	28.6	2.0	28.0	26.7	31.0
Effective dose (μSv)	AP	117	18	114	95	144
Effective dose (μSv)	PA	85	5	83	80	91
Average image estimation	AP	27.5	1.3	27.0	26.3	29.7
Average image estimation	PA	27.3	1.1	27.7	25.3	28.0

Comparison of anteroposterior and posteroanterior projection in lumbar spine radiography

Article Category: Research Article

Published Online: May 14, 2018

Page range: 468 - 474

Received: Jan 30, 2018

Accepted: Apr 18, 2018

DOI: https://doi.org/10.2478/raon-2018-0021

Keywords
lumbar spine radiography, PA projection, dose reduction, image quality

© 2018 Erna Alukic, Damijan Skrk, Nejc Mekis, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Results of patient study

Basic statistical characteristics of the phantom study

Comparison of anteroposterior and posteroanterior projection in lumbar spine radiography

Article Category: Research Article

Published Online: May 14, 2018

Page range: 468 - 474

Received: Jan 30, 2018

Accepted: Apr 18, 2018

DOI: https://doi.org/10.2478/raon-2018-0021

Keywordslumbar spine radiography, PA projection, dose reduction, image quality

© 2018 Erna Alukic, Damijan Skrk, Nejc Mekis, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Results of patient study

Basic statistical characteristics of the phantom study

Keywords
lumbar spine radiography, PA projection, dose reduction, image quality