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Comparison of Image Quality and Radiation Exposure From C-Arm Fluoroscopes When Used for Imaging the Spine

Prasarn, Mark L. MD*; Coyne, Ellen MS; Schreck, Michael MD; Rodgers, Jamie D. RT; Rechtine, Glenn R. MD

doi: 10.1097/BRS.0b013e318294e27d
Health Services Research

Study Design. Cadaveric imaging study.

Objective. We sought to compare the fluoroscopic images produced by 4 different fluoroscopes for image quality and radiation exposure when used for imaging the spine.

Summary of Background Data. There are no previous published studies comparing mobile C-arm machines commonly used in clinical practice for imaging the spine.

Methods. Anterior-posterior and lateral images of the cervical, thoracic, and lumbar spine were obtained from a cadaver placed supine on a radiolucent table. The fluoroscopy units used for the study included (1) GE OEC 9900 Elite (2010 model; General Electric Healthcare, Waukesha, WI), (2) Philips BV Pulsera (2009 model; Philips Healthcare, Andover, MA), (3) Philips BV Pulsera (2010 model; Philips Healthcare, Andover, MA), and (4) Siemens Arcadis Avantic (2010 model; Siemens Medical Solutions, Malvern, PA). The images were then downloaded, placed into a randomizer program, and evaluated by a group of spine surgeons and neuroradiologists independently. The reviewers, who were blinded to the fluoroscope the images were from, ranked them from best to worst using a numeric system. In addition, the images were rated according to a quality scale from 1 to 5, with 1 representing the best image quality. The radiation exposure level for the fluoroscopy units was also compared and was based on energy emission.

Results. According to the mean values for rank, the following order of best to worst was observed: (1) GE OEC > (2) Philips 2010 > (3) Philips 2009 > (4) Siemans. The exact same order was found when examining the image quality ratings. When comparing the radiation exposure level difference, it was observed that the OEC was the lowest, and there was a minimum 30% decrease in energy emission from the OEC versus the other C-arms studied.

Conclusion. This is the first time that the spine image quality and radiation exposure of commonly used C-arm machines have been compared. The OEC was ranked the best, produced the best quality images, and had the least amount of radiation.

We sought to compare 4 commonly used fluoroscopy machines for image quality and radiation exposure when used for imaging the entire spine. The images were evaluated by a blinded group of spine surgeons and neuroradiologists independently. The GE OEC 9900 Elite was ranked the best, produced the best quality images, and had the least amount of radiation.

*Department of Orthopaedics, University of Texas, Houston, TX

Department of Orthopaedics, University of Rochester, Rochester, NY; and

Department of Orthopaedics, Bay Pines VA Health Care System, Bay Pines, FL

Address correspondence and reprint requests to Mark L. Prasarn, MD, Department of Orthopaedics, University of Texas, 6400 Fannin, Ste 1700, Houston, TX 77030; E-mail: markprasarn@yahoo.com

Acknowledgment date: December 5, 2012. Revision date: March 19, 2013. Acceptance date: March 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Southwestern Medical Foundation grant funds were received to support this work.

Relevant financial activities outside the submitted work: expert testimony.

© 2013 by Lippincott Williams & Wilkins