title: Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice.
abstract: BACKGROUND
  Lumbar spine radiography is often performed instead of CT for radiation dose concerns.
  
  
  OBJECTIVE
  To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography.
  
  
  METHODS
  Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes.
  
  
  RESULTS
  Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv.
  
  
  CONCLUSIONS
  Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden muhammed.alshamari@regionorebrolan.se.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Alshamari
authors.affiliation: Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Geijer
authors.affiliation: Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Norrman
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lidén
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Krauss
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Franciszek
authors.initials: F
authors.lastname: Wilamowski
authors.affiliation: Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Geijer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D013122:Spinal Diseases / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Radiation dose; X-ray computed; axial skeleton; radiography; tomography