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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Establishing Protocol-based Dose Metrics for Common Abdomen and Pelvis Computed Tomography Protocols

Author(s): Entesar Zawam Dalah*, Jamila Salam Alsuwaidi, Reem Salim AlKtebi, Muna Abdellatif Ali AlMulla and Priyank Gupta

Volume 20, 2024

Published on: 07 July, 2023

Article ID: e220523217204 Pages: 8

DOI: 10.2174/1573405620666230522151357

Price: $65

Abstract

Background: The majority of the existing diagnostic reference levels (DRLs) that have been established for computed tomography (CT) are based on various anatomical locations, such as the head, chest, abdomen, etc. However, DRLs are initiated to improve radiation protection by conducting a comparison of similar examinations with similar objectives. The aim of this study was to explore the feasibility of establishing dose baselines based on common CT protocols for patients who underwent enhanced CT abdomen and pelvis exams.

Methods: Dose length product total (tDLPs), volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), effective dose (E), and scan acquisition parameters for a total of 216 adult patients, who underwent an enhanced CT abdomen and pelvis exams over a one-year period, were obtained and retrospectively analyzed. Spearman coefficient and one-way ANOVA tests were used to check significant differences between dose metrics and the different CT protocols.

Results: The data exhibited 9 different CT protocols to acquire an enhanced CT abdomen and pelvis exam at our institute. Out of these, 4 were found more common, i.e., CT protocols were acquired for a minimum of 10 cases. Triphasic liver demonstrated the highest mean and median tDLPs across all 4 CT protocols. Triphasic liver protocol registered the highest E followed by gastric sleeve protocol with a mean of 28.7 and 24.7 mSv, respectively. Significant differences (p < 0.0001) were found between the tDLPs of anatomical location and the CT protocol.

Conclusion: Evidently, wide variability exists across CT dose indices and patient dose metrics relying on anatomical-based dose baseline, i.e., DRLs. Patient dose optimizations require establishing dose baselines based on CT protocols rather than the anatomical location.

[1]
Yamada T, Hasegawa T, Yamato Y, et al. Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery. Arch Orthop Trauma Surg 2023; 143(4): 1861-7.
[PMID: 35194658]
[2]
Ledesma JA, Tran K, Lambrechts MJ, et al. Short-Segment versus long-segment spinal fusion constructs for the treatment of adult degenerative scoliosis: A comparison of clinical outcomes. World Neurosurg 2023; 171: e611-9.
[PMID: 36529425]
[3]
Hsieh MK, Li YD, Li YC, et al. Improved fixation stability for repairing pedicle screw loosening using a modified cement filling technique in porcine vertebrae. Sci Rep 2022; 12(1): 2739.
[http://dx.doi.org/10.1038/s41598-022-06724-4] [PMID: 35177724]
[4]
Shin HK, Koo HW, Kim KH, Yoon SW, Sohn MJ, Lee BJ. The usefulness of trabecular CT attenuation measurement at L4 level to predict screw loosening after degenerative lumbar fusion surgery: Consider number of fused levels and postoperative sagittal balance. Spine 2022; 47(10): 745-53.
[http://dx.doi.org/10.1097/BRS.0000000000004330] [PMID: 35102120]
[5]
Xu F, Zhou S, Zou D, Li W, Sun Z, Jiang S. The relationship between S1 screw loosening and postoperative outcome in patients with degenerative lumbar scoliosis. BMC Musculoskelet Disord 2022; 23(1): 186.
[http://dx.doi.org/10.1186/s12891-022-05107-0] [PMID: 35227237]
[6]
Lee JW, Kim HC, Kim SI, et al. Effects of bone cement augmentation for uppermost instrumented vertebra on adjacent disc segment degeneration in lumbar fusions. World Neurosurg 2023; 171: e31-7.
[PMID: 36528321]
[7]
Yoon SH, Lee SH, Jahng TA. An experimental study on the biomechanical effectiveness of bone cement-augmented pedicle screw fixation with various types of fenestrations. J Korean Neurosurg Soc 2022; 65(6): 779-89.
[http://dx.doi.org/10.3340/jkns.2021.0315] [PMID: 35970599]
[8]
Li W, Zhu H, Hua Z, et al. Vertebral bone quality score as a predictor of pedicle screw loosening following surgery for degenerative lumbar disease. Spine 2023; 2023
[http://dx.doi.org/10.1097/BRS.0000000000004577] [PMID: 36728017]
[9]
Chen Z, Lei F, Ye F, et al. Prediction of pedicle screw loosening using an MRI-based vertebral bone quality score in patients with lumbar degenerative disease. World Neurosurg 2023; 171: e760-7.
[PMID: 36584889]
[10]
Li J, Zhang Z, Xie T, Song Z, Song Y, Zeng J. The preoperative Hounsfield unit value at the position of the future screw insertion is a better predictor of screw loosening than other methods. Eur Radiol 2022; 33(3): 1526-36.
[http://dx.doi.org/10.1007/s00330-022-09157-9] [PMID: 36241918]
[11]
Lee M, Lee E, Lee JW. Value of computed tomography Hounsfield units in predicting pedicle screw loosening in the thoracic spine. Sci Rep 2022; 12(1): 18279.
[http://dx.doi.org/10.1038/s41598-022-23142-8] [PMID: 36316434]
[12]
Muheremu A, Yakufu M, Jiang J, et al. Prediction of sacral screw loosening after lumbosacral surgeries involving rigid fixation of sacral bone using preoperative computed tomography scans. Biomed Res InT 2022; 2022: 7123139.
[13]
Weegens R, Carreon LY, Voor M, Gum JL, Laratta JL, Glassman SD. Dual pitch screw design provides equivalent fixation to upsized screw diameter in revision pedicle screw instrumentation: A cadaveric biomechanical study. Spine J 2022; 22(1): 168-73.
[http://dx.doi.org/10.1016/j.spinee.2021.07.010] [PMID: 34274501]
[14]
Oberthür S, Roch PJ, Klockner F, et al. Can You Feel it? – Correlation Between Intraoperatively Perceived Bone Quality and Objectively Measured Bone Mineral Density. Global Spine J 2022; 21925682221120398.
[http://dx.doi.org/10.1177/21925682221120398] [PMID: 35993490]
[15]
Caprara S, Fasser MR, Spirig JM, et al. Bone density optimized pedicle screw instrumentation improves screw pull-out force in lumbar vertebrae. Comput Methods Biomech Biomed Engin 2022; 25(4): 464-74.
[http://dx.doi.org/10.1080/10255842.2021.1959558] [PMID: 34369827]
[16]
Heilbronner AK, Dash A, Straight BE, et al. Peripheral cortical bone density predicts vertebral bone mineral properties in spine fusion surgery patients. Bone 2023; 169: 116678.
[http://dx.doi.org/10.1016/j.bone.2023.116678] [PMID: 36646265]
[17]
Andreopoulou P. Bone health, advances in assessment and treatmentTreatment of spine disease in the elderly: Cutting edge techniques and technologies. Cham: Springer 2023; pp. 3-17.
[18]
Su YF, Tsai TH, Lieu AS, et al. Bone-mounted robotic system in minimally invasive spinal surgery for osteoporosis patients: Clinical and radiological outcomes. Clin Interv Aging 2022; 17: 589-99.
[http://dx.doi.org/10.2147/CIA.S359538] [PMID: 35497053]
[19]
Mand S, Telfer S, Battan S, et al. Assessment of regional sacral bone quality: A step towards patient‐specific fracture fixation. J Orthop Res 2023; 41(1): 141-9.
[http://dx.doi.org/10.1002/jor.25329] [PMID: 35299283]
[20]
Ogiri M, Nishida K, Park H, Rossi A. Systematic literature review and meta-analysis on the clinical outcomes of spine surgeries in patients with concurrent osteoporosis. Spine Surg Relat Res 2023.
[http://dx.doi.org/10.22603/ssrr.2022-0198]
[21]
Ko CC, Tsai HW, Huang WC, et al. Screw loosening in the Dynesys stabilization system: Radiographic evidence and effect on outcomes. Neurosurg Focus 2010; 28(6): E10.
[http://dx.doi.org/10.3171/2010.3.FOCUS1052] [PMID: 20568916]
[22]
Fasser MR, Gerber G, Passaplan C, et al. Computational model predicts risk of spinal screw loosening in patients. Eur Spine J 2022; 31(10): 2639-49.
[http://dx.doi.org/10.1007/s00586-022-07187-x] [PMID: 35461383]
[23]
Sandén B, Olerud C, Petrén-Mallmin M, Johansson C, Larsson S. The significance of radiolucent zones surrounding pedicle screws. J Bone Joint Surg Br 2004; 86-B(3): 457-61.
[http://dx.doi.org/10.1302/0301-620X.86B3.14323] [PMID: 15125138]
[24]
Yao YC, Chao H, Kao KY, et al. CT hounsfield unit is a reliable parameter for screws loosening or cages subsidence in minimally invasive transforaminal lumbar interbody fusion. Sci Rep 2023; 13(1): 1620.
[http://dx.doi.org/10.1038/s41598-023-28555-7] [PMID: 36709341]
[25]
Banno T, Hasegawa T, Yamato Y, et al. The incidence of iliac screw-related complications after long fusion surgery in patients with adult spinal deformity. Spine 2022; 47(7): 539-47.
[http://dx.doi.org/10.1097/BRS.0000000000004276] [PMID: 34798648]
[26]
Wang SK, Wang P, Li XY, Kong C, Niu JY, Lu SB. Incidence and risk factors for early and late reoperation following lumbar fusion surgery. J Orthop Surg Res 2022; 17(1): 385.
[http://dx.doi.org/10.1186/s13018-022-03273-4] [PMID: 35962390]
[27]
Pournasiri I, Farid F, Jafari HZ, et al. Screw loosening of original and non-original abutments in implant dentistry: An in vitro study. J Osseointegration 2022; 14(3): 155-8.
[28]
Kim KH, Kim TH, Kim SW, et al. Significance of measuring lumbar spine 3-Dimensional computed tomography hounsfield units to predict screw loosening. World Neurosurg 2022; 165: e555-62.
[http://dx.doi.org/10.1016/j.wneu.2022.06.104] [PMID: 35772704]
[29]
Bokov A. Pedicle screw loosening prediction in patients with degenerative diseases of lumbar spine using bone density measured in hounsfield units. J Osteopor Phys Act 2016; 4(1): 1-4.
[30]
Bredow J, Boese CK, Werner CM, et al. Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. J Osteopor Phys Act 2016; 136(8): 1063-7.

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