Skeletal Radiology

, Volume 48, Issue 3, pp 375–385 | Cite as

Radiation dose reduction for musculoskeletal computed tomography of the pelvis with preserved image quality

  • Elaina Zabak
  • Hythem Omar
  • Ethan BootheEmail author
  • Lulu Tenorio
  • Jeffrey Guild
  • Suhny Abbara
  • Avneesh Chhabra
Scientific Article



To analyze the impact of pelvic computed tomography (CT) technique optimization on estimated dose and subjective and objective image quality.

Materials and methods

An institutional review board (IRB)-approved retrospective records review was performed with waived informed consent. Five CT scanners (various manufacturers/models) were standardized to match the lowest dose profile on campus via subjective assessment of clinical images by experienced musculoskeletal radiologists. The lowest dose profile had previously been established through image assessment by experienced musculoskeletal radiologists after a department-wide radiation dose reduction initiative. A consecutive series of 60 pre- and 59 post-optimization bony pelvis CTs were analyzed by two residents, who obtained signal-to-noise ratio for femoral cortex and marrow, gluteus medius muscle, and subcutaneous and visceral fat in a standardized fashion. Two blinded attending radiologists ranked image quality from poor to excellent.


Pre- and post-optimization subjects exhibited no difference in gender, age, or BMI (p > 0.2). Mean CT dose index (CTDIvol) and dose–length product (DLP) decreased by approximately 45%, from 39± 14 to 18± 12 mGy (p < 0.0001) and 1,227± 469 to 546± 384 mGy-cm (p < 0.0001). Lower body mass index (BMI) was associated with a larger dose reduction and higher BMI with higher DLP regardless of pre- or post-optimization examination. Inter-observer agreement was 0.64–0.92 for SNR measurements. Cortex SNR increased significantly for both observers (p < 0.02). Although qualitative image quality significantly decreased for one observer (p < 0.01), adequate mean quality (3.3 out of 5) was maintained for both observers.


Subjective and objective image quality for pelvic CT examination remains adequate, despite a substantially reduced radiation dose.


Radiation dose reduction Computed tomography CT Pelvis Musculoskeletal 



Yin Xi performed our statistical analysis and created the tables and figures related to the results of this study.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Pan YN, Li AJ, Chen XM, Wang J, Ren DW, Huang QL. Coronary computed tomographic angiography at low concentration of contrast agent and low tube voltage in patients with obesity: a feasibility study. Acad Radiol. 2016;23(4):438–45.CrossRefGoogle Scholar
  2. 2.
    Patro SN, Chakraborty S, Sheikh A. The use of adaptive statistical iterative reconstruction (ASiR) technique in evaluation of patients with cervical spine trauma: impact on radiation dose reduction and image quality. Br J Radiol. 2016;17:89(1060).Google Scholar
  3. 3.
    Mangold S, Wichmann JL, Schoepf UJ, Poole Z, Canstein C, Varga-Szemes A, et al. Automated tube voltage selection for radiation dose and contrast medium reduction at coronary CT angiography using 3rd generation dual-source CT. Eur Radiol. 2016;26(10):3608–16.CrossRefGoogle Scholar
  4. 4.
    Rubin P, Casarett G. Clinical radiation pathology as applied to curative radiotherapy. Cancer. 1968;22(4):767–78.CrossRefGoogle Scholar
  5. 5.
    Ricci C, Cova M, Kang Y, Yang A, Rahmouni A, Scott W, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology. 1990;177(1):83–8.CrossRefGoogle Scholar
  6. 6.
    Cool D. Health risks from low doses and low dose-rates of ionizing radiation. Session 5: future of radiation protection regulations. Health Phys. 2016;110(3):260–1.CrossRefGoogle Scholar
  7. 7.
    Hallgren K. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Meth Psychol. 2012;8(1):23–34.CrossRefGoogle Scholar
  8. 8.
    Tsapaki V, Aldrich J, Sharma R, Staniszewska M, Krisanachinda A, Rehani M, et al. Dose reduction in CT while maintaining diagnostic confidence: diagnostic reference levels at routine head, chest, and abdominal CT—IAEA-coordinated research project. Radiology. 2016;240(3):828–34.CrossRefGoogle Scholar
  9. 9.
    Kubo T, Ohno Y, Kauczor H, Hatabu H. Radiation dose reduction in chest CT—review of available options. Eur J Radiol. 2014;83(10):1953–61.CrossRefGoogle Scholar
  10. 10.
    Singh S, Kalra M, Gilman M, Hsieh J, Pien H, Digumarthy S, et al. Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology. 2011;259(2):565–73.CrossRefGoogle Scholar
  11. 11.
    Born C, Ross S, Iannacone W, Schwab C, DeLong W. Delayed identification of skeletal injury in multisystem trauma: the ‘Missed’ fracture. J Trauma. 1989;29(12):1643–6.CrossRefGoogle Scholar
  12. 12.
    Watura R, Cobby M, Taylor J. Multislice CT in imaging of trauma of the spine, pelvis and complex foot injuries. Br J Radiol. 2014;77(1):S46–63.Google Scholar
  13. 13.
    Constantinou C, Harrington J, DeWerd L. An electron density calibration phantom for CT-based treatment planning computers. Med Phys. 1992;19(2):325–7.CrossRefGoogle Scholar
  14. 14.
    Boone J, Strauss K, Cody D, McCollough C, McNitt-Gray M, Toth T, et al. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. American Association of Physicists in Medicine Task Group 204. 2011.Google Scholar
  15. 15.
    Ghoshhajra B, Engel L, Karolyi M, Sidhu M, Wai B, Barreto M, et al. Cardiac computed tomography angiography with automatic tube potential selection: effects on radiation dose and image quality. J Thorac Imaging. 2013;28(1):40–8.CrossRefGoogle Scholar
  16. 16.
    Boos J, Lanzman R, Meineke A, Heusch L, Sawicki L, Antoch G, et al. Dose monitoring using the DICOM structured report: assessment of the relationship between cumulative radiation exposure and BMI in abdominal CT. Clin Radiol. 2015;70(2):176–82.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Elaina Zabak
    • 1
  • Hythem Omar
    • 1
  • Ethan Boothe
    • 1
    Email author
  • Lulu Tenorio
    • 1
  • Jeffrey Guild
    • 1
  • Suhny Abbara
    • 1
  • Avneesh Chhabra
    • 1
  1. 1.UT Southwestern Medical CenterDallasUSA

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