Low-dose computed tomography with tin filtration for the diagnosis of sacroiliitis –
our first experience

Česká verzia

Authors: E. Korčáková ^1,2 ; D. Suchý ³; J. Štěpánková ⁴; K. Bajcurová ^1,2; J. Pernický ¹; H. Mírka ^1,2
Authors place of work: Klinika zobrazovacích metod LF UK a FN, Plzeň ¹; Biomedicínské centrum LF UK, Plzeň ²; Oddělení klinické farmakologie LF UK a FN, Plzeň ³; Oddělení radiační fyziky FN, Plzeň ⁴
Published in the journal: Čes. Revmatol., 28, 2020, No. 4, p. 231-239.
Category: Original article

Summary

Aim: The aim of our study was to evaluate the effective radiation doses that patients received from low-dose computed tomography with tin filtration (Sn LDCT) of sacroiliac (SI) joints. We compared the doses from Sn LDCT with the doses from X-ray of SI joints and with the doses from standard CT examination of SI joints.

File: We retrospectively evaluated the imaging documentation of 52 patients who underwent targeted CT examination of SI joints in the last 5 years. For the purpose of this study, we divided them into two groups. The first group was examined by Sn LDCT and the second by a standard dose CT without tin filtration. The third group consisted of those patients (from the above-mentioned ones) who had an X-ray of SI joints.

Method: The calculation of the effective radiation dose was performed using ImpactDose 2.3, patient model – real patient data (CT Imaging GmbH, Germany) and PCXMC 2.0 (X-ray, STUK Finland).

Results: In our cohort, the effective radiation dose were 0.14 mSv (0.06–0.40 mSv) for the Sn LDCT, 0.29 mSv (0.06–1.15 mSv) for X-ray, 2.07 mSv (0.69–5.35 mSv) for SDCT. All examination methods had good quality.

Conclusion: The Sn LDCT effective radiation doses were half that of the X-ray and decimal that of the standard CT. Sn LDCT does not burden the patient with excessive radiation

Keywords:

sacroiliitis – axial spondyloarthritis – imaging – tin filtration – computed tomography

Zdroje

1. Baraliakos X, Braun J. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences? RMD Open 2015; 1(Suppl 1): e000053.

2. Bubová K. Zobrazovací metody při diagnostice a hodnocení progrese axiálních spondyloartritid. Farmakoter Revue 219; 4(3): 317–321.

3. Lambert RGW, Bakker PAC, van der Heijde D, et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 2016; 0: 1–6.

4. Rudwaleit M, van der Heide D, Landewe R. Development of ASAS for axial spondylarthritis, validation of final section.Ann Rheum Dis 2009; 68: 777–783.

5. Mandl P, Navarro-Compán V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74: 1327–1339.

6. Geijer M, Göthlin GG, Göthlin JH. The validity of the New York radiological grading criteria in diagnosing sacroiliitis by computed tomography. Acta Radiologica 2009; 50(6): 664–673.

7. Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I, et al. Imaging and interpretation of axial spondylarthritis: The radiologist’s perspective-concensus of the arthritis subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18: 265–279.

8. Melchior J, Azraq Y, Chary-Valckenaere I, et al. Radiography and abdominal CT compared with sacroiliac joint CT in the diagnosis of sacroiliitis. Acta Radiologica 2017; 58(10): 1252–1259.

9. White paper. Shaping the beam. Versatile filtration for unique diagnostic potential within Siemens Healthineers CT. Mark Woods, Marcus Brehm. https://www.siemens-healthineers.com/computed-tomography/technologies-and-innovations/tin-filter

10. Rego SL, Yu L, Bruesewitz MR, et al. CARE Dose4D CT Automatic Exposure Control System: Physics Principles and Practical Hints. https://www.mayo.edu/research/documents/care-dose-4d-ct-automatic-exposure-control-system/DOC-20086815

11. de Koning A, de Briun F, van den Berg R, et al. Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort. Ann Rheum Dis 2018; 77: 293–299.

12. Geijer M, Göthlin GG, Göthlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review. J Rheumatol 2007; 34: 1561–1565.

13. Pavelka K. Časná diagnostika ankylozující spondylitidy. Vnitř. Lék. 2006; 52(7–8): 726–729.

14. van der Heijde D, Ramíro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendation for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978–991.

15. Banegas Illescas ME, Lopez Menendez C, Rozas Rodriguez ML, Fernandez Quintero RM. New ASAS criteria for the diagnosis if spondyloarthritis: Diagnosing sacroiliitis by magnetic resonance imaging. Radiologia 2014; 56: 7–15.

16. Weber U, Baraliakos W. Imaging in axial spondyloarthritis: Changing concepts and thresholds. Best Practice & Research Clinical Rheumatology 2018; 32: 342–356.

17. Weber U, Jurik AG, Zejden A, Larsen E, Jørgensen SH, Rufibach K, et al. Frequency and anatomic distribution of magnetic resonance imaging features in the sacroiliac joints of young athletes: exploring “background noise” toward a data-driven definition of sacroiliitis in early spondyloarthritis. Arthritis Rheumatol 2018; 70(5): 736–745.

18. Ritchlin CH. Magnetic resonance imaging signals in the sacroiliac joint of healthy athletes: Refining disease thresholds and treatment strategies in axial spondyloarthritis. Arthritis Rheumatol 2018; 70(5): 629–632.

19. Diekhoff T, Hermann KGA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017; 76: 1502–1508.

20. Deodhar A. Axial spondyloarthritis criteria and modified NY criteria: issues and controversies. Clin Rheumatol 2014; 33: 741–747.

21. Chahal BS, Kwan ALC, Dillon SS, Olubaniyi BO, Jhiandri GS, Neilson MM, Lambert RGW. Radiation exposure to the sacroiliac joint from low-dose CT compared with radiography. AJR 2018; 211: 1–5.

22. Lell MM, May MS, Brand M, et al. Imaging the parasinus region with a third-generation dual-source CT and the effect of tin filtration on image quality and radiation dose. Am J Neuroradiol 2015; 36: 1225–1230.

23. Zhang G, Shi B, Sun H, et al. High-pitch low-dose abdominupelvic CT with tin-filtration technique for detecting urinary stones. Abdom Radiol 2017; 42: 2127–2134.

24. Haubenreisser H, Meyer M, Sudarski S, et al. Unenhanced third-generation dual-source chest CT using a tin filter for spectral shaping at 100 kVp. European Journal of Radiology 2015; 84: 1608–1613.