ACR–ASSR–SPR–SSR PRACTICE PARAMETER FOR THE PERFORMANCE OF SPINE RADIOGRAPHY

PREAMBLE

INTRODUCTION

II.

INDICATIONS

III.

QUALIFICATIONS AND RESPONSIBILITIES

IV.

SPECIFICATIONS OF THE EXAMINATION

IV.

SPECIFICATIONS OF THE EXAMINATION

Cervical Spine Examination

IV.

SPECIFICATIONS OF THE EXAMINATION

Thoracic Spine Examination

IV.

SPECIFICATIONS OF THE EXAMINATION

Lumbosacral Spine Examination in Adults and Children

IV.

SPECIFICATIONS OF THE EXAMINATION

Scoliosis/Spine Deformity Examination in Adults and Children

IV.

SPECIFICATIONS OF THE EXAMINATION

Examination of Infants

IV.

SPECIFICATIONS OF THE EXAMINATION

Limited Examinations

DOCUMENTATION

VI.

EQUIPMENT SPECIFICATIONS

VII.

RADIATION SAFETY IN IMAGING

VIII.

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

REFERENCES

1. Beckmann NM, West OC, Nunez D, Jr., et al. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019;16:S264-S85.
2. Almén AJ, Mattsson S. Dose distribution at radiographic examination of the spine in pediatric radiology. Spine (Phila Pa 1976). 1996 Mar 15;21(6):750-6.
3. Gialousis GI, Yakoumakis EN, Papadopoulou DI, et al. Differences in effective dose and energy imparted estimation from PA-AP, RLAT-LLAT projections in pediatric full spine x-ray examination using the Monte Carlo technique. Phys Med Biol. 2006 Jan 21;51(2):287-97.
4. American College of Radiology. ACR-AAPM-SIIM Practice Parameter for Digital Radiography. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=135+&releaseId=2
5. Hadley MN, Walters BC, Grabb PA, et al. Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5.
6. Berry GE, Adams S, Harris MB, et al. Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. J Trauma. 59(6):1410-3; discussion 1413, 2005 Dec.
7. Brockmeyer D. Down syndrome and craniovertebral instability. Topic review and treatment recommendations. Pediatr Neurosurg. 1999 Aug;31(2):71-7.
8. Freemyer B, Knopp R, Piche J, Wales L, Williams J. Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Ann Emerg Med. 1989 Aug;18(8):818-21.
9. Gale SC, Gracias VH, Reilly PM, Schwab CW. The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. Journal of Trauma-Injury Infection & Critical Care. 59(5):1121-5, 2005 Nov.
10. Griffen MM, Frykberg ER, Kerwin AJ, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan?. Journal of Trauma-Injury Infection & Critical Care. 55(2):222-6; discussion 226-7, 2003 Aug.
11. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. [Review] [21 refs]. Journal of Trauma-Injury Infection & Critical Care. 58(5):902-5, 2005 May.
12. Insko EK, Gracias VH, Gupta R, Goettler CE, Gaieski DF, Dalinka MK. Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. Journal of Trauma-Injury Infection & Critical Care. 53(3):426-9, 2002 Sep.
13. McNamara RM, Heine E, Esposito B. Cervical spine injury and radiography in alert, high-risk patients. J Emerg Med. 8(2):177-82, 1990 Mar-Apr.
14. Mirvis SE, Diaconis JN, Chirico PA, Reiner BI, Joslyn JN, Militello P. Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study. Radiology. 170(3 Pt 1):831-4, 1989 Mar.
15. Mower WR, Hoffman JR, Pollack CV, et al. Use of plain radiography to screen for cervical spine injuries. Ann Emerg Med. 2001 Jul;38(1):1-7.
16. Offerman SR, Holmes JF, Katzberg RX, Richards JR. Utility of supine oblique radiographs in detecting cervical spine injury. J Emerg Med. 2006 Feb;30(2):189-95.
17. Pollack CV Jr, Hendey GW, Martin DR, Hoffman JR, Mower WR. Use of flexion-extension radiographs of the cervical spine in blunt trauma. Annals of Emergency Medicine. 38(1):8-11, 2001 Jul.
18. Ralston ME, Chung K, Barnes PD, Emans JB, Schutzman SA. Role of flexion-extension radiographs in blunt pediatric cervical spine injury. Acad Emerg Med. 2001 Mar;8(3):237-45.
19. Ralston ME, Ecklund K, Emans JB, Torrey SB, Bailey MC, Schutzman SA. Role of oblique radiographs in blunt pediatric cervical spine injury. [Review] [28 refs]. Pediatr Emerg Care. 19(2):68-72, 2003 Apr.
20. Reinus WR, Strome G, Zwemer FL. Use of lumbosacral spine radiographs in a level II emergency department. AJR Am J Roentgenol. 1998 Feb;170(2):443-7.
21. Ross SE, O'Malley KF, DeLong WG, Born CT, Schwab CW. Clinical predictors of unstable cervical spinal injury in multiply injured patients. Injury. 1992; 23(5):317-319.
22. Schousboe JT, Rosen HR, Vokes TJ, et al. Prediction models of prevalent radiographic vertebral fractures among older women. J Clin Densitom 2014;17:378-85.
23. Swischuk LE, John SD, Hendrick EP. Is the open-mouth odontoid view necessary in children under 5 years?. Pediatr Radiol. 2000 Mar;30(3):186-9.
24. Platzer P, Jaindl M, Thalhammer G, et al. Cervical spine injuries in pediatric patients. J Trauma. 2007 Feb;62(2):389-96; discussion 394-6.
25. Smart PJ, Hardy PJ, Buckley DM, et al. Cervical spine injuries to children under 11: should we use radiography more selectively in their initial assessment?. Emerg Med J. 2003 May;20(3):225-7.
26. Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin CW. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. [Review]. CMAJ. 184(16):E867-76, 2012 Nov 06.
27. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=23+&releaseId=2.
28. Dreizin D, Letzing M, Sliker CW, et al. Multidetector CT of blunt cervical spine trauma in adults. [Review]. Radiographics. 34(7):1842-65, 2014 Nov-Dec.
29. McCulloch PT, France J, Jones DL, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma. J Bone Joint Surg Am. 2005 Nov;87(11):2388-94.
30. Inaba K, Nosanov L, Menaker J, et al. Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American Association for the Surgery of Trauma Multi-Institutional Trials Group Study. J Trauma Acute Care Surg. 78(3):459-65; discussion 465-7, 2015 Mar.
31. Nelson DW, Martin MJ, Martin ND, Beekley A. Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma. The Journal of Trauma and Acute Care Surgery. 75(1):135-9, 2013 Jul.
32. Rozzelle CJ, Aarabi B, Dhall SS, et al. Management of pediatric cervical spine and spinal cord injuries. Neurosurgery. 2013 Mar;72 Suppl 2():205-26.
33. American Academy of Pediatrics. Committee on Sports Medicine. Atlantoaxial instability in Down Syndrome. Pediatrics. 1984 Jul;74(1):152-4.
34. Atlantoaxial instability in Down syndrome: subject review. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Pediatrics. 1995 Jul;96(1 Pt 1):151-4.
35. Bull MJ, Health supervision for children with Down syndrome. Pediatrics. 2011 Aug;128(2):393-406.
36. Wyckoff AS. AAP updates guidance on caring for children with Down syndrome. AAP News 2011;32:10.
37. McAllister AS, Nagaraj U, Radhakrishnan R. Emergent Imaging of Pediatric Cervical Spine Trauma. Radiographics. 2019;39(4):1126-1142.
38. Arbuthnot M, Mooney DP. The sensitivity and negative predictive value of a pediatric cervical spine clearance algorithm that minimizes computerized tomography. Journal of Pediatric Surgery. 52(1):130-135, 2017 Jan.
39. Cui LW, Probst MA, Hoffman JR, Mower WR. Sensitivity of plain radiography for pediatric cervical spine injury. Emergency Radiology. 23(5):443-8, 2016 Oct.
40. Tat ST, Mejia MJ, Freishtat RJ. Imaging, clearance, and controversies in pediatric cervical spine trauma. [Review]. Pediatr Emerg Care. 30(12):911-5; quiz 916-8, 2014 Dec.
41. Beckmann NM, Chinapuvvula NR, Zhang X, West OC. Epidemiology and Imaging Classification of Pediatric Cervical Spine Injuries: 12-Year Experience at a Level 1 Trauma Center. AJR. American Journal of Roentgenology. 214(6):1359-1368, 2020 06.
42. Waddell VA, Connelly S. Decreasing Radiation Exposure in Pediatric Trauma Related to Cervical Spine Clearance: A Quality Improvement Project. J Trauma Nurs. 2018;25(1):38-44.
43. Battistone MJ, Manaster BJ, Reda DJ, Clegg DO. Radiographic diagnosis of sacroiliitis--are sacroiliac views really better? J Rheumatol. 1998;25(12):2395-2401.
44. Maigne JY, Tamalet B. Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine (Phila Pa 1976). 1996 Nov 15;21(22):2588-93.
45. Celestre PC, Dimar JR, Glassman SD. Spinopelvic Parameters: Lumbar Lordosis, Pelvic Incidence, Pelvic Tilt, and Sacral Slope: What Does a Spine Surgeon Need to Know to Plan a Lumbar Deformity Correction?. Neurosurg Clin N Am. 2018 Jul;29(3):S1042-3680(18)30837-4.
46. Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop. 2016 Feb;10(1):1-14.
47. American College of Radiology. ACR-SPR-SSR Practice Parameter for the Performance of Radiography for Scoliosis in Children. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=44+&releaseId=2
48. Lowe LH, Johanek AJ, Moore CW. Sonography of the neonatal spine: part 1, Normal anatomy, imaging pitfalls, and variations that may simulate disorders. AJR Am J Roentgenol. 2007;188(3):733-738.
49. Fotter R, Sorantin E, Schneider U, Ranner G, Fast C, Schober P. Ultrasound diagnosis of birth-related spinal cord trauma: neonatal diagnosis and follow-up and correlation with MRI. Pediatr Radiol. 1994;24(4):241-4.
50. American College of Radiology. ACR-AIUM-SPR-SRU Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=191+&releaseId=2
51. Rossi A, Martinetti C, Morana G, Severino M, Tortora D. Diagnostic Approach to Pediatric Spine Disorders. Magn Reson Imaging Clin N Am. 2016 Aug;24(3):S1064-9689(16)30015-0.
52. American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=74+&releaseId=2