title: Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography.
abstract: OBJECTIVE
  To compare the radiation dose, workflow, patient comfort, and financial break-even of a standard digital radiography and a biplanar low-dose X-ray system.
  
  
  METHODS
  A standard digital radiography system (Ysio, Siemens Healthcare, Erlangen, Germany) was compared with a biplanar X-ray unit (EOS, EOS imaging, Paris, France) consisting of two X-ray tubes and slot-scanning detectors, arranged at an angle of 90° allowing simultaneous vertical biplanar linear scanning in the upright patient position. We compared data of standing full-length lower limb radiographs and whole spine radiographs of both X-ray systems.
  
  
  RESULTS
  Dose-area product was significantly lower for radiographs of the biplanar X-ray system than for the standard digital radiography system (e.g. whole spine radiographs; standard digital radiography system: 392.2 ± 231.7 cGy*cm(2) versus biplanar X-ray system: 158.4 ± 103.8 cGy*cm(2)). The mean examination time was significantly shorter for biplanar radiographs compared with standard digital radiographs (e.g. whole spine radiographs: 449 s vs 248 s). Patients' comfort regarding noise was significantly higher for the standard digital radiography system. The financial break-even point was 2,602 radiographs/year for the standard digital radiography system compared with 4,077 radiographs/year for the biplanar X-ray unit.
  
  
  CONCLUSIONS
  The biplanar X-ray unit reduces radiation exposure and increases subjective noise exposure to patients. The biplanar X-ray unit demands a higher number of examinations per year for the financial break-even point, despite the lower labour cost per examination due to the shorter examination time.
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland. tobiasjdietrich@gmail.com
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Dietrich
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Schwab
authors.forename: Katja
authors.initials: K
authors.lastname: Pankalla
authors.forename: Florian M
authors.initials: FM
authors.lastname: Buck
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000191:economics* / Q000295:instrumentation; D011856:Radiographic Image Enhancement / Q000191:economics* / Q000295:instrumentation; D011874:Radiometry; D013131:Spine / Q000000981:diagnostic imaging*; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000295:instrumentation; D057188:Workflow
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