Optimising doses in patients with scoliosis.

Abstract

The purpose of the study was to review medical literature regarding the radiation risk to scoliotic patients in order to identify imaging devices, accessories and protocol design features which would reduce the dose received. As a result it was possible to have a set of guidelines on which a protocol, based on dose optimisation, was designed. The literature search was carried out through the Medline an'd Cinahl databases, and the internet. Keywords used in order to find the information required included 'scoliosis', 'patient dose', 'radiation protection' and 'dose optimisation'. Literature findings have shown that the most important techniques of dose optimisation are the PA projection instead of the AP and the high kV technique without a grid. Regarding devices, added filtration and intensity modulating attachments reduce the dose given, by absorbing the secondary photons, and produce a uniform density on the resultant radiograph. It has been found that contact and shadow shielding should be applied as a means of protecting the radiosensitive tissues of the body. It is suggested that all cassettes used have fast rare-earth screens. The most effective way of optimising patient dose while still maintaining the diagnostic linage quality desired was by using direct digital or computed radiography. In the general hospital in Malta, almost none of these devices are present and few of these techniques are applied. Once a protocol is established, based on evidence from the literature, it is recommended that it be followed to ensure dose optimisation.