title: Quality-controlled dose-reduction of pelvic X-ray examinations in infants with hip dysplasia.
abstract: BACKGROUND
  Digital plain radiography (DR) examinations of the pelvis are frequently performed in infants with hip dysplasia.
  
  
  OBJECTIVE
  The purpose was to reduce the radiation dose and to determine objective quality control criteria to ensure accurate assessment. This seems feasible because of higher quantum efficiency of DR and easy assessable anatomical structures for most orthopaedic measurements.
  
  
  METHODS
  Institutional review board approval was obtained. In this prospective randomized study, 264 patients underwent X-ray examination of the pelvis with standard and reduced dose. The evaluation of the plain-radiographs was conducted using the following criteria: acetabular and center edge angle, closing of the epiphyseal plates and maturation of the femoral head. 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 points or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The statistical analysis was conducted as non-inferiority-trial.
  
  
  RESULTS
  Five (1.9%) examined X-rays were scored as not assessable. There was no statistical inferiority between the examinations with standard (4.57 μSv) or reduced dose (3.06 μSv). Also, the individual evaluation of the defined criteria was dose-independent.
  
  
  CONCLUSIONS
  The adequate evaluation of hip dysplasia in children and young adults on pelvic radiographs is possible with reduced radiation dose, by simple using an exposure class of 800 instead of 400.
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg D-69120, Germany. Electronic address: jost.k.kloth@me.com.
authors.forename: Jost Karsten
authors.initials: JK
authors.lastname: Kloth
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg D-69120, Germany. Electronic address: regina.s.neumann@gmail.com.
authors.forename: Regina
authors.initials: R
authors.lastname: Neumann
authors.affiliation: Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, Heidelberg D-69118, Germany. Electronic address: eva.stillfried@med.uni-heidelberg.de.
authors.forename: Eva
authors.initials: E
authors.lastname: von Stillfried
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg D-69120, 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 oft he Saarland, Goebenstrasse 40, Saarbruecken D-66117, 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, Heidelberg D-69120, 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, Heidelberg D-69118, 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, Heidelberg D-69120, Germany. Electronic address: marcandre.weber@med.uni-heidelberg.de.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Weber
mesh_terms: D000077:Acetabulum; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging; D006617:Hip Dislocation / Q000000981:diagnostic imaging*; D006618:Hip Dislocation, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging*; D010808:Physical Examination; D011446:Prospective Studies; D011786:Quality Control; D011829:Radiation Dosage; D011859:Radiography; D016037:Single-Blind Method; D055815:Young Adult
keywords: Developmental dysplasia of the hip; Pelvic X-ray examination; Plain radiography; Quality management; Radiation dose reduction; Radiation protection