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Scoliosis Series Radiography: Technical Factors, Patient Positioning, and Evaluation Criteria

• A scoliosis series may include two PA projections taken for comparison, one erect and one recumbent, to determine the degree and severity of scoliosis.
• Recommended technical factors for scoliosis series include a SID of 40 to 60 inches, IR size of 14 x 17 inches or 14 x 36 inches, grid, compensating filters, and kVp range of 75-90.
• Patient positioning for scoliosis series requires the patient to be in an erect and/or recumbent position with arms at the side, evenly distributed weight on both feet for the erect position, and midsagittal plane aligned to the CR and midline of the table and/or IR.
• To minimize radiation dose to sensitive areas, a PA rather than an AP projection is highly recommended, resulting in approximately 90% reduction in dosage to the breasts.
• Shielding is necessary to protect radiosensitive tissues outside the region of interest, and examples of shielding include breast and erect markers.
• Repeat examinations over several years are often necessary, especially for pediatric patients, and careful shielding should be provided.
• The lateral position for scoliosis series is used to evaluate spondylolisthesis, degree of kyphosis, or lordosis.
• Recommended technical factors for the lateral position include a SID of 40 to 60 inches, IR size of 14 x 17 inches or 14 x 36 inches, grid, erect marker, compensating filters, and kVp range of 85-95.
• Patient positioning for the lateral position requires the patient to be in an erect lateral position with the convex side of the curve against the IR and midcoronal plane aligned to the CR and midline of the table and/or IR.
• Evaluation criteria for scoliosis series include clear demonstration of bony margins and trabecular markings of thoracic and lumbar vertebrae, no patient rotation indicated by thoracic and lumbar vertebrae with spinous processes aligned with the vertebral midline and symmetry of iliac alae/wings and upper sacrum, and no motion.
• Scoliosis may result in twisting and rotation of involved vertebrae, making some rotation unavoidable, and collimation should be to the area of interest.
• Respiration should be suspended on expiration during exposure.