title: Radiation Dose Reduction in Digital Plain Radiography of the Knee after Total Knee Arthroplasty.
abstract: OBJECTIVE
  To reduce radiation exposure of frequently performed radiographs of the knee in follow-up of total-knee arthroplasty ensuring accurate assessment by using objective quality control criteria.
  
  
  METHODS
  In this prospective randomized study 278 radiographs of the knee in follow-up of total-knee arthroplasty were performed with standard and 37% reduced radiation dose. The evaluation of the plain-radiographs was conducted using the following criteria: bone-implant interface, implant-surface character, implant-implant discrimination 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 ≥ 3 or more than 2 criteria with ≥ 2 points, the radiograph was score das "not assessable". The study was designed as non-inferiority-trial.
  
  
  RESULTS
  100% of examined radiographs were scored as assessable, hence no statistical inferiority between the examinations with standard and reduced dose could be observed. Singular assessment of the defined criteria was likewise dose-independent.
  
  
  CONCLUSIONS
  Plain-radiography of the knee following total-knee arthroplasty can be performed with 63% of standard dose without loss of diagnostic validity.
  
  
  CONCLUSIONS
  Due to the non-inferiority of digital radiographs of the knee joint after total-knee arthroplasty done with 37% reduced image receiver dose we recommend the tested speed class of SC 800 as a new reference value for digital radiographs with this indication.
authors.affiliation: Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: J K
authors.initials: JK
authors.lastname: Kloth
authors.affiliation: Center of Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Tanner
authors.affiliation: Radiology (E010), German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Stiller
authors.affiliation: Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbrücken, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Burkholder
authors.affiliation: Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: H U
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Center of Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Ewerbeck
authors.affiliation: Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011475:Prosthesis Failure; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity