Comparison of image quality, radiation dose and repeat rates for anteroposterior (AP) pelvic radiography imaging techniques (STOPPAGE study).

INTRODUCTION

Pelvic radiography is common technique for investigating hip pain, pre-operative planning and in post-surgical surveillance. Variations in anteroposterior (AP) radiographic technique have been described in the literature and are in routine practice. The aim of this study was to compare a single standardised technique (Intervention-Site 1) against individual radiographer determined techniques (Control-Site 2).

METHODS

The study was prospective in design and recruited adult ambulant patients referred for pelvic radiography. Site 1 'Intervention' used a single standardised AP technique and Site 2 'Control' allowed radiographers to determine their own optimum technique. Comparisons between the study sites included radiation dose, image quality and repeat rates. It was hypothesised that Site 1 would have lower radiation doses and fewer repeats. Demographics including sex, age and BMI were collected to ensure comparability between sites.

RESULTS

292 patients were recruited 161 (55 %) from Site 1 and 131 (45 %) Site 2. There were no statistically significant differences in terms of male to female ratio, age and BMI (p > 0.05). Median (IQR) DAP values were insignificantly lower at Site 2 11.4 (7.9-14.3) dGy.cm2 when compared to Site 1 12.9 (8.2-18.6) dGy.cm2 (p = 0.07). Repeat rates were marginally higher at Site 1 (24 %) when compared to Site 2 (19 %), but not statistically significant (p = 0.291). The missing of anatomical structures was statistically less frequent at Site 1 (12 %) when compared to Site 2 (24 %) (p = 0.009).

CONCLUSION

Initial evaluation of study data suggests that radiation doses and repeat rates were comparable. Opting for a standardised technique may yield more technically 'perfect' radiographs.

IMPLICATIONS FOR PRACTICE: Outside of radiation dose and repeat rates a standardised pelvic X-ray technique may yield improvements in technical completeness and image quality.