The cross-table lateral radiograph results in a significantly increased effective radiation dose compared with the dunn and single frog lateral radiographs

Megan Young, Molly Dempsey, Adriana De La Rocha, David A. Podeszwa

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND:: A lateral radiograph of the proximal femur is critical in the evaluation of patients with suspected femoroacetabular impingement. Positioning patients for a cross-table lateral (XTL) image is difficult, which may result in repeat exposures and increased cumulative radiation. Alternatively, the 45-degree Dunn (Dunn) and single frog lateral (SFL) views have been shown to accurately reveal proximal femoral abnormalities in femoroacetabular impingement. The purpose of this study was to compare the effective radiation doses (ERD) for 3 lateral hip projections that provide similar diagnostic information. METHODS:: Patients presenting to the adolescent hip clinic with indicated examinations were evaluated with a standard anteroposterior (AP) pelvic radiograph and one of 3 lateral hip radiographs: XTL (n=16), Dunn (n=17), or SFL (n=27). Technical exposure parameters and published reference data for an AP pelvic radiograph were used to extrapolate the ERD. A simple Pearson r correlation test determined the relationships between body mass index, age, and ERD. The rate of repeat exposures per study was calculated. RESULTS:: Body mass index positively correlated (r=0.34) and age and negatively correlated (r=-0.27) with ERD. ERD was increased for the XTL (0.83±0.98 mSv) over the Dunn (0.37±0.15 mSv) and SFL (0.22±0.11 mSv; P<0.05). Repeat exposures were performed in 10.4%, 4%, and 6% of XTL, Dunn, and SFL studies, respectively. CONCLUSIONS:: The ERD for a single projection is highest for the XTL, and the examination is more likely to be repeated. The XTL radiograph should be avoided whenever possible and substituted with alternative images providing similar diagnostic information, such as the Dunn or SFL, to minimize lifetime cumulative radiation exposure to the patient. LEVEL OF EVIDENCE:: Level II.

Original languageEnglish (US)
Pages (from-to)157-161
Number of pages5
JournalJournal of Pediatric Orthopaedics
Volume35
Issue number2
DOIs
StatePublished - Mar 14 2015

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Anura
Radiation
Femoracetabular Impingement
Hip
Body Mass Index
Patient Positioning
Thigh
Femur

Keywords

  • cross-table lateral radiograph
  • Dunn lateral radiograph
  • effective radiation dose
  • femoroacetabular impingement
  • frog lateral radiograph

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

The cross-table lateral radiograph results in a significantly increased effective radiation dose compared with the dunn and single frog lateral radiographs. / Young, Megan; Dempsey, Molly; De La Rocha, Adriana; Podeszwa, David A.

In: Journal of Pediatric Orthopaedics, Vol. 35, No. 2, 14.03.2015, p. 157-161.

Research output: Contribution to journalArticle

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title = "The cross-table lateral radiograph results in a significantly increased effective radiation dose compared with the dunn and single frog lateral radiographs",
abstract = "BACKGROUND:: A lateral radiograph of the proximal femur is critical in the evaluation of patients with suspected femoroacetabular impingement. Positioning patients for a cross-table lateral (XTL) image is difficult, which may result in repeat exposures and increased cumulative radiation. Alternatively, the 45-degree Dunn (Dunn) and single frog lateral (SFL) views have been shown to accurately reveal proximal femoral abnormalities in femoroacetabular impingement. The purpose of this study was to compare the effective radiation doses (ERD) for 3 lateral hip projections that provide similar diagnostic information. METHODS:: Patients presenting to the adolescent hip clinic with indicated examinations were evaluated with a standard anteroposterior (AP) pelvic radiograph and one of 3 lateral hip radiographs: XTL (n=16), Dunn (n=17), or SFL (n=27). Technical exposure parameters and published reference data for an AP pelvic radiograph were used to extrapolate the ERD. A simple Pearson r correlation test determined the relationships between body mass index, age, and ERD. The rate of repeat exposures per study was calculated. RESULTS:: Body mass index positively correlated (r=0.34) and age and negatively correlated (r=-0.27) with ERD. ERD was increased for the XTL (0.83±0.98 mSv) over the Dunn (0.37±0.15 mSv) and SFL (0.22±0.11 mSv; P<0.05). Repeat exposures were performed in 10.4{\%}, 4{\%}, and 6{\%} of XTL, Dunn, and SFL studies, respectively. CONCLUSIONS:: The ERD for a single projection is highest for the XTL, and the examination is more likely to be repeated. The XTL radiograph should be avoided whenever possible and substituted with alternative images providing similar diagnostic information, such as the Dunn or SFL, to minimize lifetime cumulative radiation exposure to the patient. LEVEL OF EVIDENCE:: Level II.",
keywords = "cross-table lateral radiograph, Dunn lateral radiograph, effective radiation dose, femoroacetabular impingement, frog lateral radiograph",
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AU - Young, Megan

AU - Dempsey, Molly

AU - De La Rocha, Adriana

AU - Podeszwa, David A.

PY - 2015/3/14

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N2 - BACKGROUND:: A lateral radiograph of the proximal femur is critical in the evaluation of patients with suspected femoroacetabular impingement. Positioning patients for a cross-table lateral (XTL) image is difficult, which may result in repeat exposures and increased cumulative radiation. Alternatively, the 45-degree Dunn (Dunn) and single frog lateral (SFL) views have been shown to accurately reveal proximal femoral abnormalities in femoroacetabular impingement. The purpose of this study was to compare the effective radiation doses (ERD) for 3 lateral hip projections that provide similar diagnostic information. METHODS:: Patients presenting to the adolescent hip clinic with indicated examinations were evaluated with a standard anteroposterior (AP) pelvic radiograph and one of 3 lateral hip radiographs: XTL (n=16), Dunn (n=17), or SFL (n=27). Technical exposure parameters and published reference data for an AP pelvic radiograph were used to extrapolate the ERD. A simple Pearson r correlation test determined the relationships between body mass index, age, and ERD. The rate of repeat exposures per study was calculated. RESULTS:: Body mass index positively correlated (r=0.34) and age and negatively correlated (r=-0.27) with ERD. ERD was increased for the XTL (0.83±0.98 mSv) over the Dunn (0.37±0.15 mSv) and SFL (0.22±0.11 mSv; P<0.05). Repeat exposures were performed in 10.4%, 4%, and 6% of XTL, Dunn, and SFL studies, respectively. CONCLUSIONS:: The ERD for a single projection is highest for the XTL, and the examination is more likely to be repeated. The XTL radiograph should be avoided whenever possible and substituted with alternative images providing similar diagnostic information, such as the Dunn or SFL, to minimize lifetime cumulative radiation exposure to the patient. LEVEL OF EVIDENCE:: Level II.

AB - BACKGROUND:: A lateral radiograph of the proximal femur is critical in the evaluation of patients with suspected femoroacetabular impingement. Positioning patients for a cross-table lateral (XTL) image is difficult, which may result in repeat exposures and increased cumulative radiation. Alternatively, the 45-degree Dunn (Dunn) and single frog lateral (SFL) views have been shown to accurately reveal proximal femoral abnormalities in femoroacetabular impingement. The purpose of this study was to compare the effective radiation doses (ERD) for 3 lateral hip projections that provide similar diagnostic information. METHODS:: Patients presenting to the adolescent hip clinic with indicated examinations were evaluated with a standard anteroposterior (AP) pelvic radiograph and one of 3 lateral hip radiographs: XTL (n=16), Dunn (n=17), or SFL (n=27). Technical exposure parameters and published reference data for an AP pelvic radiograph were used to extrapolate the ERD. A simple Pearson r correlation test determined the relationships between body mass index, age, and ERD. The rate of repeat exposures per study was calculated. RESULTS:: Body mass index positively correlated (r=0.34) and age and negatively correlated (r=-0.27) with ERD. ERD was increased for the XTL (0.83±0.98 mSv) over the Dunn (0.37±0.15 mSv) and SFL (0.22±0.11 mSv; P<0.05). Repeat exposures were performed in 10.4%, 4%, and 6% of XTL, Dunn, and SFL studies, respectively. CONCLUSIONS:: The ERD for a single projection is highest for the XTL, and the examination is more likely to be repeated. The XTL radiograph should be avoided whenever possible and substituted with alternative images providing similar diagnostic information, such as the Dunn or SFL, to minimize lifetime cumulative radiation exposure to the patient. LEVEL OF EVIDENCE:: Level II.

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KW - femoroacetabular impingement

KW - frog lateral radiograph

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