Jost Karsten Kloth1, Markus Rickert2, Tobias Gotterbarm3, Wolfram Stiller4, Iris Burkholder5, Hans-Ulrich Kauczor6, Volker Ewerbeck7, Marc-André Weber8. 1. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: jost.kloth@med.uni-heidelberg.de. 2. Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Klinikstrasse 33, D-35392 Giessen, Germany. Electronic address: markus.rickert@ortho.med.uni-giessen.de. 3. Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: tobias.gotterbarm@med.uni-heidelberg.de. 4. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: wolfram.stiller@med.uni-heidelberg.de. 5. Department of Nursing and Health, University of Applied Sciences of the Saarland, Goebenstrasse 40, D-66117 Saarbruecken, Germany. Electronic address: stabil@burkholder.de. 6. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: hans-ulrich.kauczor@med.uni-heidelberg.de. 7. Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: volker.ewerbeck@med.uni-heidelberg.de. 8. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Electronic address: marcandre.weber@med.uni-heidelberg.de.
Abstract
OBJECTIVE: Digital plain radiographs of the pelvis are frequently performed in follow-up examinations of patients who received total hip arthroplasty (THA) or osteosynthesis (OS). Thus, the purpose was to reduce the radiation dose and to determine objective quality control criteria to ensure accurate assessment. MATERIALS AND METHODS: Institutional review board approval was obtained. In this prospective randomized study, 289 patients underwent X-ray examination of the pelvis as follow up after receiving THA or OS with standard and reduced dose. The evaluation of the plain radiographs was conducted using the following criteria: bone-implant interface, implant-implant discrimination, implant-surface character and periarticular heterotopic ossification. 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 or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as non-inferiority-trial. RESULTS: Seven (2.4%) examined X-rays were scored as not assessable. There was no statistical inferiority between the examinations with standard (0.365 mSv) or reduced dose (0.211 mSv). Reduced dose only led to limitations in the evaluation of ceramic components with low clinical impact in most scenarios. CONCLUSION:Plain radiography of the pelvis in patients with THA or OS can be performed with a dose reduction of about 42% without a loss of important information. The obtained quality control criteria were clinically applicable.
RCT Entities:
OBJECTIVE: Digital plain radiographs of the pelvis are frequently performed in follow-up examinations of patients who received total hip arthroplasty (THA) or osteosynthesis (OS). Thus, the purpose was to reduce the radiation dose and to determine objective quality control criteria to ensure accurate assessment. MATERIALS AND METHODS: Institutional review board approval was obtained. In this prospective randomized study, 289 patients underwent X-ray examination of the pelvis as follow up after receiving THA or OS with standard and reduced dose. The evaluation of the plain radiographs was conducted using the following criteria: bone-implant interface, implant-implant discrimination, implant-surface character and periarticular heterotopic ossification. 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 or more than 2 criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as non-inferiority-trial. RESULTS: Seven (2.4%) examined X-rays were scored as not assessable. There was no statistical inferiority between the examinations with standard (0.365 mSv) or reduced dose (0.211 mSv). Reduced dose only led to limitations in the evaluation of ceramic components with low clinical impact in most scenarios. CONCLUSION: Plain radiography of the pelvis in patients with THA or OS can be performed with a dose reduction of about 42% without a loss of important information. The obtained quality control criteria were clinically applicable.
Authors: Mi Ran Jeon; Hee Jin Park; So Yeon Lee; Kyung A Kang; Eun Young Kim; Hyun Pyo Hong; Inyoung Youn Journal: Br J Radiol Date: 2017-10-27 Impact factor: 3.039