INTRODUCTION: Pelvic radiographs are commonly used for the investigation of a variety of conditions. Comparison between examinations requires a consistent radiographic technique but variations in image quality and radiographic centring points are frequently reported in the literature. The aim of this study was to establish the amount of variation in the radiographic centring point (RCP) and pelvic axial rotation (PAR), with a secondary aim of reporting the reliability of such measures. METHODS: Using a previously acquired imaging archive, 633 adult pelvis/hip radiographs were identified on a Picture Archiving and Communication System (PACS). Radiographs with bilateral prostheses, evidence of acute pelvic trauma, projections acquired on a stretcher/trolley and those demonstrating large discontinuity between the detector and X-ray field centre were excluded. To determine centring point variation (+ values denote superior variations) and axial rotation multiple measurements were obtained from each radiograph. A video was used to train five observers and each of these reviewed ten random cases to determine inter- and intra-rater reliability. One of the five observers then performed the measurements on all remaining radiographs. RESULTS: Following exclusions 380 radiographs were evaluated. The median (IQR) RCP deviation from the inter-acetabular line was +22 (+2 to +43) mm where both iliac crests were present and -29 (-45 to -12) mm where they were not. Eleven (3%) cases demonstrate RCP variation from the midline of greater than 25 mm (no bias towards the left or right side). The median (IQR) PAR was 0.0 (-1.5 to 1.4) degrees with greater variance in PAR for male participants (p = 0.004). Almost 60% of inter-rater ICC measurements were categorised as excellent, good or moderate. CONCLUSION: Variations in RCP and PAR exist when evaluating a sample of routinely acquired pelvis radiographs. Some initial factors, such as sex and sub-examination type (full pelvis [XPEL] or low centred pelvis [XHIPB]) have been identified as having a statistical affect on variability. Further research and methods to standardise radiographic techniques is required and must be multidimensional in nature. IMPLICATIONS FOR PRACTICE: Selection of radiographic technique, including RCP, appears to influence components of the pelvis radiograph. Given the increasing clinical requirements for pelvic radiography further standardisation alongside individual optimisation is warranted.

Purpose: Quantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy. Methods: Internationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp. Armonck, NY, USA). Results and conclusion: the effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography.The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm2 which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm2), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm2) is lower than for four view functional radiography (7.34 Gy cm2).Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm2) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data.Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased. © 2014 the College of Radiographers.

Objective: Measuring continuous lumbar spine motion in vivo and in vitro could advance our understanding of instability, for example accurately and reliably measuring translation in the sa gittal plane may help in the management of spondylolisthesis. The Anglo-European College of Chiropractic (AECC) has developed a method of measuring in vivo continuous inter-vertebral motion in the spine using fluoroscopy and image processing - a method called OSMIA (objective spinal motion imaging assessment). This method can measure both inter-vertebral rotation and translation; however it is unknown how accurate and repeatable this method is for translation in the sagittal plane. This study has been performed to determine the accuracy in vitro and repeatability in vivo of the measurement of inter-vertebral translation using OSMIA. Design: Prospective in vitro accuracy and retrospective in vivo repeatability study. Setting: Anglo-European College of Chiropractic, United Kingdom. Subjects: Continuous lumbar fluoroscopic sequences in vivo were obtained from 10 patients (mean age 38 years, SD 10.2, 42% male) who had previously undergone OSMIA scans using a passive recumbent protocol which negated the action of muscle and motor control on inter-vertebral motion. Methods: for accuracy, calibration model images of the lumbar spine with zero translation were acquired and others' imaged with digital fluoroscopy at 15. Hz during continuous flexion and extension. For inter-examiner repeatability, two observers blinded to each other's results analysed 10 in vivo lumbar spine fluoroscopy flexion and extension motion sequences for range of translation using automated tracking algorithms. For intra-examiner repeatability, one observer performed the analysis twice. Accuracy was calculated as the root-mean-square (RMS) difference between the known calibration model characteristics and the results acquired from the fluoroscopic sequences. Repeatability was calculated as agreement by standard errors of measurement (SEM) and 95% limits of agreement and reliability by intra class correlation coefficients (ICC) for each inter-vertebral level (L2-S1) from the in vivo motion sequences. Results: the RMS error in measuring translation against the reference standard was under 0.8. mm in respect to a standard lumbar vertebra of 35. mm depth. With the exception of L5-S1 extension, the SEMs from the in vivo agreement studies were below 0.5. mm for all levels and directions (flexion-extension), and for reliability the ICCs were above 0.84. Conclusions: OSMIA successfully measures inter-vertebral translation in vivo and in vitro in passive recumbent motion of the lumbar spine with greater repeatability and accuracy than previously reported studies using fluoroscopy. © 2012 the College of Chiropractors.

Quantitative fluoroscopy (QF) is an emerging technology for measuring intervertebral motion patterns to investigate problem back pain and degenerative disc disease. This International Forum was a networking event of three research groups (UK, US, Hong Kong), over three days in San Francisco in August 2009. Its aim was to reach a consensus on how best to record, analyse, and communicate QF information for research and clinical purposes. The Forum recommended that images should be acquired during regular trunk motion that is controlled for velocity and range, in order to minimise externally imposed variability as well as to correlate intervertebral motion with trunk motion. This should be done in both the recumbent passive and weight bearing active patient configurations. The main recommended outputs from QF were the true ranges of intervertebral rotation and translation, neutral zone laxity and the consistency of shape of the motion patterns. The main clinical research priority should initially be to investigate the possibility of mechanical subgroups of patients with chronic, nonspecific low back pain by comparing their intervertebral motion patterns with those of matched healthy controls.

Study Design. Prospective fluoroscopic and electromyographic study of coronal plane lumbar spine motion in healthy male volunteers. ObjectiveS. Assess the intervertebral motion profiles in healthy volunteers for symmetry, regularity, and neutral zone laxity during passive recumbent lateral bending motion. Summary of Background Data. Previous continuous in vivo motion studies of the lumbar spine have mainly been limited to active, weight-bearing, flexion-extension (sagittal plane) motion. No data are available for passive lateral bending or to indicate the motion profiles when muscle activity is minimized. Methods. Thirty asymptomatic male volunteers underwent video-fluoroscopy of their lumbar spines during passive, recumbent lumbar lateral bending through 80° using a motor-driven motion table. Approximately 120 consecutive images of segments L2-L5 were captured, and the position of each vertebra was tracked throughout the sequence using automated frame-to-frame registration. Reference intervals for intervertebral motion parameters were calculated. Surface electromyography recordings of erector spinae were obtained in a similar group of volunteers using the same protocol without fluoroscopy to determine to what extent the motion was completely passive. Results. Correlations between intervertebral and lumbar motion were always positive in controls and asymmetry was less than 55% of intervertebral range. The upper reference interval for the slope of intervertebral rotation in the first 10° of trunk motion did not exceed 0.46 for any level. Muscle electrical activity during the motion was very low. Examples from patient studies showed markedly different results. Conclusion. These results suggest that reference limits from asymptomatic data for coronal plane passive recumbent intervertebral motion may be a useful resource for investigating the relationship between symptoms of chronic (nonspecific) low back pain and biomechanics and in the clinical assessment of patients and interventions that target the passive holding elements of the spine. Data pooling from multiple studies would be necessary to establish a complete database. © 2009, Lippincott Williams & Wilkins.

Purpose: the purpose of this research was to identify the extent and scope of changes to radiography practice. Method: Questionnaires were sent to radiology managers at acute National Health Service (NHS) hospitals in 2000 as a follow-up to an initial survey conducted in 1998. Information was sought on region, teaching/non-teaching status, the nature of extended role tasks undertaken and the year in which these tasks were first undertaken. Results: Some 172 questionnaires were returned from a total of 253 dispatched (68%). In 161 hospitals radiographers administered intravenous injections and performed barium enemas in 119 hospitals, while a red-dot system was in operation in 141 hospitals. Reporting by radiographers had increased since 1998. Replies indicated that, at 124 hospitals, radiographers were reporting in ultrasound. Skeletal reporting was the second most-frequently-reported activity, with 63 hospitals indicating that radiographers reported in this modality, while barium enemas were reported by radiographers in 34 hospitals. Reporting was also undertaken by radiographers in mammography, nuclear medicine, paediatrics and chest radiography in a small minority of hospitals. There was no statistically significant difference between the adoption of tasks in non-teaching and teaching hospitals with the exception of radiographer-performed barium enemas (P=0.014) and red-dot systems (P=0.05). Radiographers were more likely to undertake both of these activities at non-teaching hospitals than in teaching hospitals. Regional differences were apparent in reporting, with a greater prevalence in the English regions than Northern Ireland, Scotland and Wales. Conclusion: the study provided data that demonstrated the extent to which hospitals are utilizing the developing skills of radiographers. This has important implications for future education and training needs for radiographers and for delivery of imaging services. © 2002 the College of Radiographers. Published by Elsevier Science Ltd. All rights reserved.