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Low-dose biplanar radiography can be used in children and adolescents to accurately assess femoral and tibial torsion and greatly reduce irradiation

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Abstract

Purpose

To evaluate in children the agreement between femoral and tibial torsion measurements obtained with low-dose biplanar radiography (LDBR) and CT, and to study dose reduction ratio between these two techniques both in vitro and in vivo.

Materials and methods

Thirty children with lower limb torsion abnormalities were included in a prospective study. Biplanar radiographs and CTs were performed for measurements of lower limb torsion on each patient. Values were compared using Bland-Altman plots. Interreader and intrareader agreements were evaluated by intraclass correlation coefficients. Comparative dosimetric study was performed using an ionization chamber in a tissue-equivalent phantom, and with thermoluminescent dosimeters in 5 patients.

Results

Average differences between CT and LDBR measurements were –0.1° ±1.1 for femoral torsion and –0.7° ±1.4 for tibial torsion. Interreader agreement for LDBR measurements was very good for both femoral torsion (FT) (0.81) and tibial torsion (TT) (0.87). Intrareader agreement was excellent for FT (0.97) and TT (0.89). The ratio between CT scan dose and LDBR dose was 22 in vitro (absorbed dose) and 32 in vivo (skin dose).

Conclusion

Lower limb torsion measurements obtained with LDBR are comparable to CT measurements in children and adolescents, with a considerably reduced radiation dose.

Key points

• LDBR and CT lower-limb torsion measurements are comparable in children and adolescents.

• LDBR considerably reduced radiation dose necessary for lower-limb torsion measurements.

• LDBR can be used for evaluation of lower limb-torsion in orthopaediatric patients.

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Abbreviations

CTDI:

Computed tomography dose index

TLD:

radiothermoluminescent detectors

DLP:

dose-length product

LDBR:

Low dose biplanar radiography

FT:

Femoral torsion

TT:

Tibial torsion

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Acknowledgments

We have greatly appreciated the kind help and support of the whole Toulouse children hospital radiology department, especially Barjorie, Barracca, Maryse and Marie Claire.

The scientific guarantor of this publication is Dr Christiane Baunin. The authors of this manuscript declare relationships with the following company: ALRA Expertise. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors Dr Agnes Sommet has significant statistical expertise and provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective, observational and experimental on phantom, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, CHU Toulouse Purpan, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France

    Olivier Meyrignac, Christiane Baunin, Julie Vial & Nicolas Sans

  2. ALARA Expertise, 27 rue du Général de Gaulle, 67205, Oberhausbergen, France

    Ramiro Moreno

  3. Department of Orthopedics, Hôpital des Enfants, CHU Toulouse Purpan, 330 avenue de Grande-Bretagne, TSA 70034, 31059, Toulouse Cedex 9, France

    Franck Accadbled & Jérome Sales de Gauzy

  4. Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France

    Agnes Sommet

Authors
  1. Olivier Meyrignac
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  2. Ramiro Moreno
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  3. Christiane Baunin
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  4. Julie Vial
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  5. Franck Accadbled
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  6. Agnes Sommet
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  7. Jérome Sales de Gauzy
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  8. Nicolas Sans
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Correspondence to Olivier Meyrignac.

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Meyrignac, O., Moreno, R., Baunin, C. et al. Low-dose biplanar radiography can be used in children and adolescents to accurately assess femoral and tibial torsion and greatly reduce irradiation. Eur Radiol 25, 1752–1760 (2015). https://doi.org/10.1007/s00330-014-3560-8

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  • DOI: https://doi.org/10.1007/s00330-014-3560-8

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