Benefits and unexpected artifacts of biplanar digital slot-scanning imaging in children

Abstract

Biplanar digital slot-scanning allows for relatively low-dose orthopedic imaging, an advantage in imaging children given the growing concerns regarding radiosensitivity. We have used this system for approximately 1 year for orthopedic imaging of the spine and lower extremities. We have noted advantages of using the digital slot-scanning system when compared with computed radiographic and standard digital radiographic imaging systems, but we also found unexpected but common imaging artifacts that are the direct result of the imaging method and that have not been reported. This pictorial essay serves to familiarize radiologists with the advantages of the digital slot-scanning system as well as imaging artifacts common with this new technology.

Upright Biplanar Slot Scanning in Pediatric Orthopedics: Applications, Advantages, and Artifacts

“…Compared with standard digital radiography, EOS examinations generally require less time and labor of the radiology technologists [35,36]. Dietrich et al [35] showed statistically significant reductions in examination times, with biplanar radiography requiring only 248 seconds to complete versus 449 seconds for standard digital radiography.…”

“…These include patient motion artifacts, edge enhancement, potential underestimation of leg-length discrepancy, and the "off-center" artifact [36].…”

“…8). Cardiac motion often produces an undulating left-heart border because the image is acquired during systole and diastole [36] (Fig. 8).…”

“…9). A potential solution for this includes taping a round metallic marker to the patient's skin to serve as a reference [36].…”

Spinal phantom comparability study of Cobb angle measurement of scoliosis using digital radiographic imaging

“…Previous studies documented an estimated cumulative radiation exposure of 15 mSv due to periodic radiographic follow-ups, leading to notably increased cancer risk in AIS patients [26] , [27] . With the use of microdose EOS, a 58% dose reduction with the effective dose reduced from 233 mSv to 98.7 mSv could be achieved [28] , [29] . Another study also confirmed a 6- to 9-fold of average skin dose reduction in the thoracoabdominal region, with the use of slot-scanning imaging instead of CR [19] .…”