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

Zsuzsanna Deak; Lindis Brummund; Sonja Kirchhoff; Markus Körner; Lucas Geyer; Fabian Mück; Mariano Scaglione; Maximilian Reiser; Ulrich Linsenmaier

doi:10.3390/diagnostics12081872

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

Diagnostics (Basel). 2022 Aug 2;12(8):1872. doi: 10.3390/diagnostics12081872.

Authors

Zsuzsanna Deak^{1

2}, Lindis Brummund², Sonja Kirchhoff^{3

4}, Markus Körner^{2

5}, Lucas Geyer^{2

6}, Fabian Mück^{2

7}, Mariano Scaglione^{8

9}, Maximilian Reiser², Ulrich Linsenmaier^{2

7}

Affiliations

¹ Imaging Urania, Laurenzenberg 2, 1010 Wien, Austria.
² Departmant of Radiology, University Hospital LMU, Marchioninistraße 15, 81377 Munich, Germany.
³ Department of Forensic Medicine, Ludwig-Maximilians-University of Munich, Nußbaumstraße 26, 80336 Munich, Germany.
⁴ Radiologische Praxis Maximilianstraße, Maximilianstr. 34, 84028 Munich, Germany.
⁵ Radiologie Mühleninsel, Mühlenstraße 4, 84028 Landshut, Germany.
⁶ Radiologisches Zentrum München, Pippinger Straße 25, 81245 Munich, Germany.
⁷ Institute for Diagnostic and Interventional Radiology, HELIOS Kliniken München West, München Perlach & Augustinum München, Steinerweg 5, 81241 Munich, Germany.
⁸ Department of Radiology, University of Sassary, 07100 Sassari, Italy.
⁹ James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK.

Abstract

The purpose of this experimental study on recently deceased human cadavers was to investigate whether (I) the radiation exposure of the cervical spine CT can be reduced comparable to a dose level of conventional radiography (CR); and (II) whether and which human body parameters can be predictive for higher dose reduction potential (in this context).

Materials and methods: Seventy serial CT scans of the cervical spine of 10 human cadavers undergoing postmortem virtual autopsy were taken using stepwise decreasing upper limits of the tube current (300 mAs, 150 mAs, 110 mAs, 80 mAs, 60 mAs, 40 mAs, and 20 mAs) at 120 kVp. An additional scan acquired at a fixed tube current of 300 mAs served as a reference. Images were reconstructed with filtered back projection and the upper (C1-4) and lower (C4-7) cervical spine were evaluated by three blinded readers for image quality, regarding diagnostic value and resolution of anatomical structures according to a semiquantitative three-point-scale. Dose values and individual physical parameters were recorded. The relationship of diagnostic IQ, dose reduction level, and patients' physical parameters were investigated. The high-contrast resolution of the applied CT protocols was tested in an additional phantom study.

Results: The IQ of the upper cervical spine was diagnostic at 1.69 ± 0.58 mGy (CTDI) corresponding to 0.20 ± 0.07 mSv (effective dose) in all cadavers. IQ of the lower cervical spine was diagnostic at 4.77 ± 1.86 mGy corresponding to 0.560 ± 0.21 mSv (effective dose) in seven cadavers and at 2.60 ± 0.93 mGy corresponding to 0.31 ± 0.11 mSv in four cadavers. Significant correlation was detected for BMI (0.8366; p = 0.002548) and the anteroposterior (a.p.) chest diameter (0.8363; p = 0.002566), shoulder positioning (0.79799; p = 0.00995), and radiation exposure.

Conclusions: Conventional radiography can be replaced with a nearly dose-neutral CT scan of the cervical spine.

Keywords: cervical spine; computed tomography; conventional radiography; dose index; emergency radiology; trauma patients.

Grants and funding

This research received no external funding.