Radiostereometric analysis: comparison of radiation dose and precision in digital and computed radiography

Background Radiostereometric Analysis (RSA) is used to measure fixation of joint prosthesis. This study compared radiation dose and image quality of a digital radiography (DR) RSA system and a computed radiography (CR) RSA system in a clinical setting. Methods RSA recordings of 24 hips and shoulders were analyzed. We compared two systems: (1) Arcoma T0 with ST-VI image plates and Profect CR-IR 363 reader to (2) AdoraRSA with CXDI-70C wireless DR detectors in a clinical uniplanar RSA set-up with a +/- 20 degrees tube angulation and 35 cm x 43 cm detectors. Effective dose was calculated using dedicated software. Image quality was evaluated using calibration errors as calculated by the RSA software. Results The mean dose for hips was 0.14 (SD 0.04) mSv in the CR system and 0.05 (SD 0.02) mSv in the DR system. The mean dose for shoulders was 0.16 (SD 0.07) mSv in the CR system and 0.09 (SD 0.03) mSv in the DR system. Radiation dose was 64% (p < 0.001) and 43% (p = 0.03) lower in the DR system compared with the CR system for hip and shoulder RSA, respectively. Image quality was better for the DR system with 60-80% less calibration errors compared to the CR system. Conclusion Owing to highly efficient detectors and added filtration at the x-ray tubes, the DR system considerably reduced radiation dose compared with the CR system without compromising image quality. Based on the findings in this study, we recommend replacing CR RSA systems with DR RSA systems. Registration Patients were selected from clinical studies performed on the two systems and approved by the local ethics committee [20060165, M-20100112, M-20070082, M-20110224, and 20070258] and registered with ClinicalTrials.gov [NCT00408096, NCT01289834, NCT00913679, NCT02311179, and NCT00679120].