title: Comparison of image quality and radiation exposure from C-arm fluoroscopes when used for imaging the spine.
abstract: METHODS
  Cadaveric imaging study.
  
  
  OBJECTIVE
  We sought to compare the fluoroscopic images produced by 4 different fluoroscopes for image quality and radiation exposure when used for imaging the spine.
  
  
  BACKGROUND
  There are no previous published studies comparing mobile C-arm machines commonly used in clinical practice for imaging the spine.
  
  
  METHODS
  Anterior-posterior and lateral images of the cervical, thoracic, and lumbar spine were obtained from a cadaver placed supine on a radiolucent table. The fluoroscopy units used for the study included (1) GE OEC 9900 Elite (2010 model; General Electric Healthcare, Waukesha, WI), (2) Philips BV Pulsera (2009 model; Philips Healthcare, Andover, MA), (3) Philips BV Pulsera (2010 model; Philips Healthcare, Andover, MA), and (4) Siemens Arcadis Avantic (2010 model; Siemens Medical Solutions, Malvern, PA). The images were then downloaded, placed into a randomizer program, and evaluated by a group of spine surgeons and neuroradiologists independently. The reviewers, who were blinded to the fluoroscope the images were from, ranked them from best to worst using a numeric system. In addition, the images were rated according to a quality scale from 1 to 5, with 1 representing the best image quality. The radiation exposure level for the fluoroscopy units was also compared and was based on energy emission.
  
  
  RESULTS
  According to the mean values for rank, the following order of best to worst was observed: (1) GE OEC > (2) Philips 2010 > (3) Philips 2009 > (4) Siemans. The exact same order was found when examining the image quality ratings. When comparing the radiation exposure level difference, it was observed that the OEC was the lowest, and there was a minimum 30% decrease in energy emission from the OEC versus the other C-arms studied.
  
  
  CONCLUSIONS
  This is the first time that the spine image quality and radiation exposure of commonly used C-arm machines have been compared. The OEC was ranked the best, produced the best quality images, and had the least amount of radiation.
authors.affiliation: Department of Orthopaedics, University of Texas, Houston, TX 77030, USA. markprasarn@yahoo.com
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.forename: Ellen
authors.initials: E
authors.lastname: Coyne
authors.forename: Michael
authors.initials: M
authors.lastname: Schreck
authors.forename: Jamie D
authors.initials: JD
authors.lastname: Rodgers
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Rechtine
mesh_terms: D002102:Cadaver; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards*; D005471:Fluoroscopy / Q000379:methods / Q000592:standards*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D015203:Reproducibility of Results; D013131:Spine / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging