Lowered dose full-spine radiography in pediatric patients with idiopathic scoliosis

Lowered dose full-spine radiography in pediatric patients with idiopathic scoliosis

Caroline Ernst, Nico Buls, Armand Laumen, Gert Van Gompel, Filip Verhelle, Johan de Mey

May 2018, Volume 27, Issue 5, pp 1089 - 1095
First Online: 27 March 2018


To optimize our standard full-spine radiography with respect to diagnostic quality and dose.


A phantom study was performed to establish an optimal posterior–anterior view (PA) full spine protocol having the lowest dose with non-inferior quality compared to standard. We then applied this protocol in 40 pediatric patients (group B). The radiographs were scored on six criteria by a pediatric radiologist and orthopedist and compared to the scores of 40 PA full spine radiographs performed in 2013 with standard protocol (group A). Radiation dose was assessed by dose area product (DAP) and effective dose (E). Statistical analysis included independent samples t test, Mann–Whitney U test and intra-class correlation coefficient (ICC).


An optimized protocol was defined (0.2 mm Cu filter, 0.87 relative exposure, with grid). Mean age was 13.3 ± 1.6 years for group A and 13.4 ± 1.7 years for group B. For group B, the mean DAP was 47.0 µGy m2 with an E of 0.13 mSv. For group A, the mean DAP was 85.3 µGy m2 with an E of 0.24 mSv. This represents a dose reduction of 45%. Mean image quality scores for group A (27.9 ± 2.4) and group B (28.1 ± 2.3) were similar (p = 0.612). Interobserver agreement was observed to be excellent (ICC 0.92).


This study demonstrates that a low-dose full-spine radiograph can be performed in patients with idiopathic scoliosis without loss of image quality.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]