title: Clinical magnification error in lateral spinal digital radiographs.
abstract: METHODS
  Observational.
  
  
  OBJECTIVE
  The objectives of this study were to determine the range of clinical magnification error in lateral spinal digital radiographs, and to determine the effect of body mass index (BMI) on this error.
  
  
  BACKGROUND
  The magnification error in plain radiographs is often estimated at 15% to 30%. The variability of this error in digital spinal radiographs has not been assessed.
  
  
  METHODS
  An analysis of 250 patients with digital radiographs and computed tomography (CT)/magnetic resonance images (MRIs) was performed. Digital imaging software was used to measure the anteroposterior vertebral body dimensions at C2, C5, L1, and L4. Magnification values were determined in comparison to CT/MRI. CT measurements were also compared with MRI. BMI for each patient was obtained by chart review.
  
  
  RESULTS
  The mean magnification at the cervical spine (C2 and C5 combined) was 1.22 +/- 0.01, with a range of 1.06 to 1.57 (n = 198, STDEV = 0.08); at the lumbar spine (L1 and L4 combined) it was 1.31 +/- 0.01, with a range of 1.09 to 1.63 (n = 300, STDEV = 0.08). The difference between the mean anteroposterior vertebral body dimensions as measured on CT and MRI was < 0.1 mm (n = 135, P < 0.2514, paired t test). There was a significant positive correlation between BMI and magnification at both the cervical and lumbar spines by linear regression (Cervical: n = 99; P = 0.0019; Lumbar: n = 150; P < 0.0001). There was a significant difference in magnification between nonobese and obese patients at both the cervical and lumbar levels. Cervical: 1.19 +/- 0.01 magnification for nonobese (n = 144), versus 1.26 +/- 0.01 for obese (n = 39) (P < 0.0001). Lumbar: 1.28 +/- 0.01 (n = 208), versus 1.38 +/- 0.01 (n = 78) (P < 0.0001), respectively.
  
  
  CONCLUSIONS
  Linear clinical measurements obtained on digital radiographs are subject to significant magnification errors at both the cervical and lumbar spines. This error correlates to the patient's BMI. Consequently, clinical decision-making that is based on linear measurements obtained from radiographs that do not account for this error is invalid. In a scenario where this measurement is crucial (e.g., dynamic radiographs), this error can be corrected by comparison to morphometric data from a CT/MRI.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bheeshma
authors.initials: B
authors.lastname: Ravi
authors.forename: Raja
authors.initials: R
authors.lastname: Rampersaud
mesh_terms: D016477:Artifacts; D015992:Body Mass Index; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009765:Obesity / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D011873:Radiology Information Systems; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D014057:Tomography, X-Ray Computed