Should Plain Films of the Lumbar Spine be Taken in the Posterior-to-Anterior or Anterior-to-Posterior Position? A Study Using Decision Analysis

ObjectiveThe objective of this study was to mathematically propose the best position for frontally oriented lumbar spine radiographs.MethodsDecision analysis with a decision tree was used in this study. Factors used in the analysis were radiation dose, ease of implementation, image quality, cost, and patient comfort. Data on these factors were gathered by reviewing the literature.ResultsRadiation dose was found to be the only factor with significant differences between the posterior-to-anterior (PA) position and the anterior-to-posterior (AP) position, and PA films gave lower doses to sensitive organs as compared with AP films. There is also some evidence that PA films show better overall image quality as compared with AP films.ConclusionsBased on the information used in this study, lumbar spine plain film radiographs should be obtained in the PA position.