Congress:
EuroSafe Imaging 2019
Keywords:
Action 7 - Radiation protection of children, Musculoskeletal spine, CT, Diagnostic procedure, Trauma
Authors:
S. ARSLAN, M. R. Onur, Y. Sarikaya, H. N. ÖZCAN, M. Haliloglu, D. Akata
DOI:
10.26044/esi2019/ESI-0060
Conclusion and recommendations
Polytrauma patients with suspicion of spine injury usually undergo plain radiography in emergency departments.
However,
difficulty of positioning for appropriate radiograph acquisition and low sensitivity constitute drawbacks of plain radiography in detection of spine injury.
CT is more adequate in patients with suspected spinal injury (7).
In our study,
50% of the patients with spine injury had normal plain radiography which denotes necessity of CT in emergency spine settings.
Spine CT should be performed with appropriate protocols that account radiation dose reduction considerations.
Scan length should be limited to region of interest.
Overscanning in patients with spine CT results in unnecessary radiation dose exposure.
Spine CT examinations can be performed in different CSL and kV values.
Higher kV values and thinner CSL resulted in higher CTDIvol ve DLP values therefore increased radiation dose in our study.
Lowering kV values may not decrease diagnostic accuracy of CT in detecting spine injuries since spine fractures do not require increased contrast resolution compared to soft tissues.
Increasing CSL values to decrease radiation dose may be controversial in terms of detecting subtle spine fractures.
However subtle fractures do not require surgical repair and conservative management is preferred in these cases.
Severe fractures with contour deformity and decreased vertebra height can be detected on topogram images.
High CSL values may be used in CT examinations of these patients since evaluation of this type of severe fractures do not necessitate acquisition of CT images with CSL values < 2 mm.
Our study's limitations were the few number of patients in the 0-7 and 7-14 age groups and absence of body mass index (BMI) values of patients that affect patient radiation dose.
As a result; general recommendations to reduce the radiation dose in children include;
- Justification of spine CT examination in childhood.
- Preferring imaging modalities that do not use ionizing radiation in childhood spine trauma.
- Keep in mind these: Higher energy,
higher tube current,
thinner slice collimation,
lower pitch,
slower gantry rotation time and increasing the scan length increase radiation dose.