Skin and thyroid dosimetry in cervical spine screening: two methods for evaluation and a comparison between a helical CT and radiographic trauma series.

Abstract

The first objective of this study was to test the hypothesis that estimates of radiation dose from an ionization chamber correspond to thermoluminescent dosimeter measurements in patients with suspected cervical spine injury. The second objective was to compare the radiation dose of a protocol using helical CT of the entire cervical spine with that of a protocol using radiography alone. Thermoluminescent dosimeter measurements of radiation dose to the skin over the thyroid were made in two patient groups: six patients evaluated with CT of the cervical spine and six patients evaluated with radiography. The skin dose for both groups was estimated with an ionization chamber, and the thermoluminescent dosimeter measurements and ionization chamber estimates of skin dose were compared for both groups. Using the ionization chamber, we estimated the radiation dose to the thyroid for all 12 patients. With these estimates, we computed the ratios of skin dose and thyroid dose (CT / radiography). Thermoluminescent dosimeter measurements correlated with ionization chamber estimates of skin dose in both patient groups. Using the ionization chamber estimates, we found that CT delivered 26.0 mGy to the thyroid. In the patients evaluated with radiography, the mean thyroid dose was 1.80 mGy (95% confidence interval, 1.05-2.55 mGy). Ionization chamber dose ratios (CT / radiography) for the skin and thyroid were 9.69 and 14.4 mGy, respectively. The correlation between the ionization chamber estimates and the thermoluminescent dosimeter measurements supports the use of ionization chamber estimates in future research. Although helical CT of the entire cervical spine is cost-effective in patients at high risk for fracture, the greater than 14-fold increase in the radiation dose to the thyroid emphasizes the importance of clinical stratification to identify patients at high risk for fracture and the judicious use of CT in patients with suspected cervical spine injury.