title: Pelvic X-ray examinations in follow-up of hip arthroplasty or femoral osteosynthesis--dose reduction and quality criteria.
abstract: OBJECTIVE
  Digital plain radiographs of the pelvis are frequently performed in follow-up examinations of patients who received total hip arthroplasty (THA) or osteosynthesis (OS). Thus, the purpose was to reduce the radiation dose and to determine objective quality control criteria to ensure accurate assessment.
  
  
  METHODS
  Institutional review board approval was obtained. In this prospective randomized study, 289 patients underwent X-ray examination of the pelvis as follow up after receiving THA or OS with standard and reduced dose. The evaluation of the plain radiographs was conducted using the following criteria: bone-implant interface, implant-implant discrimination, implant-surface character and periarticular heterotopic ossification. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score of 3 or more or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as non-inferiority-trial.
  
  
  RESULTS
  Seven (2.4%) examined X-rays were scored as not assessable. There was no statistical inferiority between the examinations with standard (0.365 mSv) or reduced dose (0.211 mSv). Reduced dose only led to limitations in the evaluation of ceramic components with low clinical impact in most scenarios.
  
  
  CONCLUSIONS
  Plain radiography of the pelvis in patients with THA or OS can be performed with a dose reduction of about 42% without a loss of important information. The obtained quality control criteria were clinically applicable.
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: jost.kloth@med.uni-heidelberg.de.
authors.forename: Jost Karsten
authors.initials: JK
authors.lastname: Kloth
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Klinikstrasse 33, D-35392 Giessen, Germany. Electronic address: markus.rickert@ortho.med.uni-giessen.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Rickert
authors.affiliation: Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: tobias.gotterbarm@med.uni-heidelberg.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gotterbarm
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: wolfram.stiller@med.uni-heidelberg.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Stiller
authors.affiliation: Department of Nursing and Health, University of Applied Sciences of the Saarland, Goebenstrasse 40, D-66117 Saarbruecken, Germany. Electronic address: stabil@burkholder.de.
authors.forename: Iris
authors.initials: I
authors.lastname: Burkholder
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: hans-ulrich.kauczor@med.uni-heidelberg.de.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: volker.ewerbeck@med.uni-heidelberg.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Ewerbeck
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: marcandre.weber@med.uni-heidelberg.de.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001822:Body Burden; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011829:Radiation Dosage; D011835:Radiation Protection; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed
keywords: Pelvic X-ray examination; Quality management; Radiation dose reduction; Radiation protection; Total hip arthroplasty