Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography

Skeletal Radiol. 2013 Jul;42(7):959-67. doi: 10.1007/s00256-013-1600-0. Epub 2013 Mar 28.


Objective: To compare the radiation dose, workflow, patient comfort, and financial break-even of a standard digital radiography and a biplanar low-dose X-ray system.

Materials and methods: A standard digital radiography system (Ysio, Siemens Healthcare, Erlangen, Germany) was compared with a biplanar X-ray unit (EOS, EOS imaging, Paris, France) consisting of two X-ray tubes and slot-scanning detectors, arranged at an angle of 90° allowing simultaneous vertical biplanar linear scanning in the upright patient position. We compared data of standing full-length lower limb radiographs and whole spine radiographs of both X-ray systems.

Results: Dose-area product was significantly lower for radiographs of the biplanar X-ray system than for the standard digital radiography system (e.g. whole spine radiographs; standard digital radiography system: 392.2 ± 231.7 cGy*cm(2) versus biplanar X-ray system: 158.4 ± 103.8 cGy*cm(2)). The mean examination time was significantly shorter for biplanar radiographs compared with standard digital radiographs (e.g. whole spine radiographs: 449 s vs 248 s). Patients' comfort regarding noise was significantly higher for the standard digital radiography system. The financial break-even point was 2,602 radiographs/year for the standard digital radiography system compared with 4,077 radiographs/year for the biplanar X-ray unit.

Conclusion: The biplanar X-ray unit reduces radiation exposure and increases subjective noise exposure to patients. The biplanar X-ray unit demands a higher number of examinations per year for the financial break-even point, despite the lower labour cost per examination due to the shorter examination time.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Leg / diagnostic imaging*
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data*
  • Radiation Dosage
  • Radiation Protection / economics*
  • Radiation Protection / instrumentation
  • Radiographic Image Enhancement / economics*
  • Radiographic Image Enhancement / instrumentation
  • Radiometry
  • Spine / diagnostic imaging*
  • Switzerland / epidemiology
  • Tomography, X-Ray Computed / economics*
  • Tomography, X-Ray Computed / instrumentation
  • Workflow*