A pilot study investigating two dose reduction techniques for AP lumbar spine radiography using direct dosimetry and Projection VR

Introduction The purpose of this study was to compare radiation dose measurements generated using a virtual radiography simulation with experimental dosimeter measurements for two radiation dose reduction techniques in digital radiography. Methods Entrance Surface Dose (ESD) measurements were generated for an antero-posterior lumbar spine radiograph experimentally using NanoDOT TM, single point dosimeters, for two radiographic systems (systems 1 and 2) and using Projection VR TM, a virtual radiography simulation (system 3). Two dose reduction methods were tested, application of the 15% kVp rule, or simplified 10 kVp rule, and the exposure maintenance formula. The 15% or 10 kVp rules use a specified increase in kVp and halving of the mAs to reduce patient ESD. The exposure maintenance formula uses the increase in source-to-object distance to reduce ESD. Results Increasing kVp from 75 to 96 kVp, with the concomitant decrease in mAs, resulted in percent ESD reduction of 59.5% (4.02-1.63 mGy), 60.8% (3.55-1.39 mGy), and 60.3% (6.65-2.64 mGy), for experimental systems 1 and 2, and virtual simulation (system 3), respectively. Increasing the SID (with the appropriate increase in mAs) from 100 to 140 cm reduced ESD by 22.3% 18.8%, and 23.5%, for experimental systems 1 and 2, and virtual simulation (system 3), respectively. Conclusion Percent dose reduction measurements were similar between the experimental and virtual measurement systems investigated. For the dose reduction practices tested, Projection VR TM provides a realistic alternate of percent dose reduction to direct dosimetry