title: [Modern digital plain-radiography of the whole spine in scoliosis patients--dose reduction and quality criteria].
abstract: OBJECTIVE
  To reduce the radiation exposure of plain radiographs of the entire spine depending on specific indications, since these are frequently performed examinations of children and young adults with scoliosis and to determine objective quality control criteria to ensure accurate assessment.
  
  
  METHODS
  In this prospective randomized study 323 patients underwent plain-radiography of the entire spine with standard and 50 % reduced dose. In an experimental pilot-study this target-dose was determined using an Alderson-Phantom. The evaluation of the experimental radiographs, as well as, the randomized plain-radiographs was conducted using the following criteria: endplates (Cobb-angle), spinal process and pedicel (rotation), lateral margin of the vertebral body (lateral alignment), identification of C7 / S1 (perpendicular). Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If one single criteria was evaluated with a score of 3 or more points or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The statistical analysis was conducted as a non-inferiority-trial.
  
  
  RESULTS
  Seven (2.4 %) of the 290 examined x-rays were scored as not assessable. There was no statistic inferiority between the examinations with standard or reduced dose, while singular assessment of the defined criteria was likewise dose-independent.
  
  
  CONCLUSIONS
  Plain-radiography of the total spine in patients with scoliosis can be performed with a dose reduction of 50% without a loss of validity. The obtained quality control criteria were clinically applicable.
authors.affiliation: Diagnostische und Interventionelle Radiologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, Heidelberg. jost.kloth@med.uni-heidelberg.de
authors.forename: J K
authors.initials: JK
authors.lastname: Kloth
authors.forename: B
authors.initials: B
authors.lastname: Wiedenhoefer
authors.forename: W
authors.initials: W
authors.lastname: Stiller
authors.forename: I
authors.initials: I
authors.lastname: Burkholder
authors.forename: H-U
authors.initials: HU
authors.lastname: Kauczor
authors.forename: V
authors.initials: V
authors.lastname: Ewerbeck
authors.forename: M-A
authors.initials: MA
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001822:Body Burden; D002648:Child; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011874:Radiometry / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D013131:Spine / Q000000981:diagnostic imaging*; D055815:Young Adult