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Initial Assessment of a Prototype 3D Cone-Beam Computed Tomography System for Imaging of the Lumbar Spine, Evaluating Human Cadaveric Specimens in the Upright Position

Benz, Robyn Melanie, MD*; Harder, Dorothee, MD*; Amsler, Felix; Voigt, Johannes, PhD; Fieselmann, Andreas, PhD; Falkowski, Anna Lucja*; Stieltjes, Bram, MD, PhD*; Hirschmann, Anna, MD*

doi: 10.1097/RLI.0000000000000495
Original Articles

Objectives The aims of this study were to assess feasibility, image quality, and radiation dose and to estimate the optimal dose protocol for the lumbar spine of cadaveric specimens with different body mass indices (BMIs) in the upright position using a prototype 3-dimensional cone-beam computed tomography (CT) software implemented on a robotic x-ray system and compare with CT.

Materials and Methods The lumbar spine of 5 formalin-fixed human cadaveric specimens (BMI, 22–35 kg/m2) was prospectively assessed in the upright position using prototype software for 3-dimensional tomography implemented on a robotic x-ray system. Specimens were scanned with varying kilovolt values (70, 81, 90, 100, 109, 121 kV) and thereafter with 80 kV (BMI ≤30 kg/m2) and 121 kV (BMI >30 kg/m2) and varying dose levels (DLs; 0.278, 0.435, 0.548, 0.696, 0.87, 1.09). Computed tomography data were acquired with a standard clinical protocol. Two independent readers rated visibility of the cortex, endplates, facet joints, trabeculae, neuroforamina, posterior alignment, and spinal canal as well as nerve roots. Radiation dose was measured with a cylindrical CTDI phantom. Descriptive statistics and analysis of variance were used (P < 0.05).

Results Average intraclass correlation was excellent (0.94). The lowest technically possible kilovolt and the highest technically possible DL yielded the best image quality. In specimens with a BMI of 30 kg/m2 or less, depiction of all structures was good and comparable to CT, except for nerve roots. For specimens with a BMI greater than 30 kg/m2, image quality was limited.

Conclusions Three-dimensional cone-beam CT of the lumbar spine in cadaveric specimens in the upright position is feasible. An optimal dose protocol was estimated. Depiction of osseous structures is comparable to CT in specimens with BMI of 30 kg/m2 or less. Image quality is limited for soft tissue structures and specimens with BMI greater than 30 kg/m2.

From the *Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel,

Amsler Consulting, Basel, Switzerland; and

Siemens Healthcare GmbH, Erlangen, Germany.

Received for publication April 11, 2018; and accepted for publication, after revision, May 21, 2018.

Conflicts of interest and sources of funding: Anna Hirschmann received a grant by Siemens Healthcare GmbH (Erlangen/Germany). The work of the coauthors from Siemens was limited to the support of the conception of the dose protocols. The dose-length product was calculated by one of the coauthors of Siemens according to the dose measurements that were assessed at our institution.

The authors report no conflicts of interest.

Correspondence to: Robyn Melanie Benz, MD, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.