Comparative analysis of lateral cervical radiographic imaging quality with and without anti-scatter grid application

This study investigated the effects of anti-scatter grid removal on radiation dose, image quality, and anatomical visibility in lateral (LAT) cervical spine imaging.

A two-part prospective study was conducted. In the phantom study, an anthropomorphic head-torso phantom with lard simulating extra fatty tissue of 2-10 cm in 2 cm increments was imaged using protocols with and without an anti-scatter grid. In the clinical study, 80 patients were randomly divided into two groups: half were imaged with an anti-scatter grid, and half without. Data collected included gender, body mass index (BMI), Dose Area Product (DAP), tube voltage (kV), current-time product (mAs), filtration, neck width, and use of Automatic Exposure Control (AEC). Effective dose (ED) and dose to selected organs were calculated using PCXMC 2.0 software. Two traumatologists and one radiologist evaluated all phantom and patient images according to European guidelines using a four-point scale (1 = diagnostically inadequate image; 4 = excellent image quality).

In the phantom study, removal of the anti-scatter grid reduced mean DAP by 52.1 % (p < 0.001) without affecting diagnostic adequacy; soft tissue-bone contrast improved (p = 0.009). In the patient study, removal of the anti-scatter grid reduced mean DAP and ED by 63.1 % and 61.7 %, respectively (both p < 0.001). All organ doses were significantly lower (p < 0.001). Soft tissue visibility improved by 12.5 % (p = 0.011), and soft tissue-bone contrast improved by 9.1 % (p = 0.007) without the anti-scatter grid. No other quality criteria differed significantly.

In both phantom and patient studies, removal of the anti-scatter grid resulted in significant dose reduction while maintaining or improving image quality. These results are consistent with previous findings and support the As Low As Reasonably Achievable (ALARA) principle. Omitting the anti-scatter grid in LAT cervical spine imaging reduces dose by about 60 % without compromising diagnostic quality. Routine use in clinical practice is recommended to increase patient safety.