LUMBAR SPINE RADIOGRAPHY: LOWER ORGAN

DOSE WITH THE USE OF PA PROJECTION

Erna Alukic and Nejc Mekiš

Prepared by : Hala Rabee ID\S1811023

Alquds university\faculty of graduate studies
Supervisor :Dr-Hussein Al-Masri

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 Introduction
• Lumbar spine radiography is a very common
and frequent procedure with one of the
highest patient radiation dose in general
radiography

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 Introduction
• Exposure to ionising radiation, even at low
doses, may cause damage to genetic material
Ionizing radiation

11/11/2020 Stochastic effects 3

 Introduction
• It is essential to use as low doses possible and
to protect the organs at risk such as:
 Colon, lungs, stomach and active bone
marrow
 Male and female reproductive organs and
females’ breasts which are in the immediate
vicinity of the lumbar spine

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 Introduction
• (AP) projections of the abdominal region produce
higher effective doses than posteroanterior (PA)
projections, as most radiosensitive organs within the
abdomen (primary field) are closer to the entry
surface of the ionising radiation

• The use of PA projection in lumbar spine radiography

to reduce radiation dose
Larger distance of the Spine and pelvis as a
radiosensitive organs sheild

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 Introduction
• The purpose of the research was to determine
whether the use of PA projection of lumbar
spine radiography lowers the:
• entrance surface dose (ESD)
• effective dose and organ dose to the patient
in digital radiography.

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 Materials and methods
• The research was performed on 100 patients and
were randomly divided into two groups of 50.
• The exposure parameters used in the study were
79kV.
• Each patient’s height and weight were measured,
on the basis of which a BMI was calculated.
Furthermore, the DAP, EXI (exposure index),
mAs, image field size and source to patient
distance were acquired.
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 Materials and methods
• Effective dose and organ dose calculations
• The effective dose and organ dose calculations
were made using the Monte Carlo simulation
program
 The calculated effective dose was based on the tissue
weighting factors of ICRP publication 103.
 (Organ dose)the selected organs included active bone
marrow, colon, gallbladder, liver, lungs, small intestine,
stomach, urinary bladder, ovaries, breasts, uterus, testis
and prostate
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 Materials and methods
• Dosimetry
• For each patient, the ESD was calculated from
tube output. The used formula was:

BSF is back scatter factor

Y(d) signifies the tube output per mAs measured at the distance of
100cm.
SPD is source to patient distance
It is used for the tube current-time product

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 Results
• Results regarding the BMI, EXI, ESD and effective
dose:

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 Results
• Results regarding the BMI, EXI, ESD and effective
dose:
 The analysis of the BMI and EXI was performed to
ensure that there was no difference between the two
groups
 The use of PA projection decreased the ESD (by 33%
(0.6mGy)
 The average effective dose was lower by 53%
(90.2μSv).

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 Results
• Comparison of organ doses in AP and PA projection:

The dose to selected

organs that lie close
to the primary field or
in the primary field
was decreased from
43% up to 86%.
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 Discussion
• The use of PA projection in a lumbar spine radiography
decreased the ESD by 33% (0.6mGy).

• The mean effective dose was reduced by 53% (90.2

μSv) which shows statistically significant
difference between AP and PA projection in lumbar
spine imaging.

• Reduction in the dose to the selected organs by 43–

86% for almost all the selected organs
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 Discussion
• The only organ that showed an increase of the
absorbed dose by factor four was the active
bone marrow 28% higher in PA than AP
projection.

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 Conclusion
• Based on the results the PA projection should
be a method of choice in the lumbar spine
radiography, except for:
 The patients with acute injuries
 Stomach pains
 Respiratory distress

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