title: Should plain films of the lumbar spine be taken in the posterior-to-anterior or anterior-to-posterior position? A study using decision analysis.
abstract: OBJECTIVE
  The objective of this study was to mathematically propose the best position for frontally oriented lumbar spine radiographs.
  
  
  METHODS
  Decision analysis with a decision tree was used in this study. Factors used in the analysis were radiation dose, ease of implementation, image quality, cost, and patient comfort. Data on these factors were gathered by reviewing the literature.
  
  
  RESULTS
  Radiation dose was found to be the only factor with significant differences between the posterior-to-anterior (PA) position and the anterior-to-posterior (AP) position, and PA films gave lower doses to sensitive organs as compared with AP films. There is also some evidence that PA films show better overall image quality as compared with AP films.
  
  
  CONCLUSIONS
  Based on the information used in this study, lumbar spine plain film radiographs should be obtained in the PA position.
authors.affiliation: Young Radiology Consulting, Nottingham, England. kjy@youngradiology.com
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Young
mesh_terms: D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D011859:Radiography / Q000191:economics / Q000379:methods*