title: Effect of spinal immobilisation devices on radiation exposure in conventional radiography and computed tomography.
abstract: Trauma patients at risk for, or suspected of, spinal injury are frequently transported to hospital using full spinal immobilisation. At the emergency department, immobilisation is often maintained until radiological work-up is completed. In this study, we examined how these devices influence radiation exposure and noise, as a proxy for objective image quality. Conventional radiographs (CR) and computer tomography (CT) scans were made using a phantom immobilised on two types of spineboard and a vacuum mattress and using two types of headblocks. Images were compared for radiation transmission and quantitative image noise. In CR, up to 23 % and, in CT, up to 11 % of radiation were blocked by the devices. Without compensation for the decreased transmission, noise increased by up to 16 % in CT, depending on the device used. Removing the headblocks led to a statistically significant improvement in transmission with automatic exposure control (AEC) enabled. Physicians should make an informed decision whether the increased radiation exposure outweighs the risk of missing a clinically significant injury by not making a CR or CT scan. Manufacturers of immobilisation devices should take radiological properties of their devices into account in the development and production process.
authors.affiliation: Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands. baukjehemmes@hotmail.com.
authors.forename: Baukje
authors.identifier: http://orcid.org/0000-0002-5802-4924
authors.initials: B
authors.lastname: Hemmes
authors.affiliation: Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Cécile R L P N
authors.initials: CR
authors.lastname: Jeukens
authors.affiliation: Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Kemerink
authors.affiliation: Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
authors.affiliation: Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.|NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
mesh_terms: D006801:Humans; D007103:Immobilization / Q000295:instrumentation*; D019047:Phantoms, Imaging; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging / Q000502:physiology / Q000528:radiation effects*; D014057:Tomography, X-Ray Computed
keywords: Computed tomography (CT); Conventional radiography (CR); Image quality; Radiation exposure; Spinal immobilisation