title: Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction.
abstract: OBJECTIVE
  Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy.
  
  
  METHODS
  Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n= 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA).
  
  
  CONCLUSIONS
  The effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography. The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm2which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm2), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm2) is lower than for four view functional radiography (7.34 Gy cm2). Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm2) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data. Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.
authors.affiliation: Anglo European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK ; Poole Hospital Foundation Trust, Longfleet Road, Poole BH15 2JB, UK.
authors.forename: F E
authors.initials: FE
authors.lastname: Mellor
authors.affiliation: Clinical Research Unit, School of Health and Social Care, Bournemouth University, Bournemouth BH1 3LT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Anglo European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK.
authors.forename: A
authors.initials: A
authors.lastname: Breen
keywords: Continuous motion; Flexion-extension; Inter-vertebral; Low back pain; Movement disorders; Spine kinematics