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

Dietrich, Tobias Johannes; Pfirrmann, Christian W. A.; Schwab, Adolf J.; Pankalla, Katja; Buck, Florian M.

doi:10.1007/s00256-013-1600-0

Cited by 93 publications

(54 citation statements)

References 24 publications

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“…Due to the incomplete description of the methodology and the results, there is some doubt regarding the clinical relevance of the conclusions [2]. Compared to the corresponding values of Dietrich et al which used a mean dose area product of 9.2 cGyc × cm 2 ± 4.6 cGyc × cm 2 for 185 consecutive X-ray stereotactic whole leg images, the dose area product in this study was somewhat higher, with 12.5 cGyc × cm 2 ± 4.1 cGyc × cm 2 for sagittal images [15]. The diagnostic image quality was not evaluated by Dietrich et al In summary, the EOS X-ray stereotactic imaging system, in the context of whole leg imaging, can be employed only for position control.…”

Section: Muskuloskelettales System 71mentioning

confidence: 41%

“…Since the indications justifying exact three-dimensional radiological determination of skeletal angle in the patient population of an orthopedic specialty clinic compared to conventional skeletal diagnostics are likely to be relatively rare, an X-ray stereotactic system used only for angle and position determination will generally not be fully utilized in the course of daily activities [2, 15]. Dietrich et al compared the processes of EOS technology with the characteristics of standard digital technology (Ysio, Siemens Healthcare) for the generation of 133 whole spine images and 185 whole leg images [15]. According to Dietrich et al the financial break-even point for Swiss economic circumstances was 4 X-ray stereotactic examinations per work day instead of 3 whole spine examinations performed per work day using the standard system [15].…”

mentioning

confidence: 99%

“…Dietrich et al compared the processes of EOS technology with the characteristics of standard digital technology (Ysio, Siemens Healthcare) for the generation of 133 whole spine images and 185 whole leg images [15]. According to Dietrich et al the financial break-even point for Swiss economic circumstances was 4 X-ray stereotactic examinations per work day instead of 3 whole spine examinations performed per work day using the standard system [15]. An increase in utilization frequency and improvement of the operating costs of EOS technology could be achieved if the system could also be used for position verification in morphological skeletal diagnostics.…”

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confidence: 99%

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Comparison of image quality using a X-ray stereotactical whole-body system and a direct flat-panel X-ray device in examinations of the pelvis and knee

Krug

Weber

Schwabe

et al. 2013

Fortschr Röntgenstr

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Purpose: The novel biplanar X-ray unit ?EOS?, EOS Imaging, allows to acquire simultaneously 2 perpendicular planes of full-length spine and limbs and to measure spatially correct angles based on the acquired image data sets. This is to be seen alongside with a low spatial resolution, high investment costs and high operating expenses. The use of the biplanar X-ray unit in morphology based scelettal radiography might improve the cost-benefit-relation. Thus, the purpose of this study was to compare image quality of the EOS-unit and the flat panel (FP)-technology as reference in a clinical setting. Materials and Methods: All 114 patients of the Orthopedic Hospital Dept., who had a biplanar full-length lower limb radiograph and a FP-examination of the pelvis and/or the knee with maximum time interval of 3?months without changes in the clinical and radiological findings were included in the study. All X-ray examinations had been carried out due to clinical indications. Secondary captures comparable to the FP-images were extracted from the electronic EOS-image data sets. 4 radiologists independently from each other compared the visualization of normal anatomical structures of the pseudonymous EOS- and FP-images in a randomized order. Results: In the overwiew of all readers and all sceletal regions image quality of the FP-images was considered being superior in a mean of 83???13?% standard deviation of the pair comparisons (minimum 48?%, maximum 100?%). Image quality of the EOS-images was assessed as being superior in 2???3?% of the cases (0?%, 10?%). Image quality of 0.8???3?% of the FP-images (0?%, 17?%) and 30???34?% (0?%, 100?%) of the EOS-images was estimated as diagnostically inadequate. 30???33?% of the pair comparisons (0?%, 100?%) showed a diagnostically inadequate image quality of the EOS-images and a diagnostically good image quality of the FP-images. Conclusion: Image quality of biplanar full-length lower limb X-ray examinations is not suitable to be used for the diagnostic assessment of the morphological bone structure using the currently available technological setting. Key points: Citation Format:

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Section: Muskuloskelettales System 71mentioning

confidence: 41%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of image quality using a X-ray stereotactical whole-body system and a direct flat-panel X-ray device in examinations of the pelvis and knee

Krug

Weber

Schwabe

et al. 2013

Fortschr Röntgenstr

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“…Compared to standard radiographs, image acquisition using these low-dose biplanar radiographs leads to a substantial reduction of radiation dose (up to 6-18 times) [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Assessment of two-dimensional (2D) and three-dimensional (3D) lower limb measurements in adults: Comparison of micro-dose and low-dose biplanar radiographs

2016

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“…Our study statistically confirmed the non-inferiority of post-TKA digital radiographs with an image receptor dose reduced by 37 % when compared to the standards of the German Federal Office for Radiation. In addition, with regard to further technical developments such as reduceddose biplanar stereo radiography systems [17,18], the possibility of prospectively guided, statistically grounded quality assurance is demonstrated. Digital radiographic images of the knee joint after endoprosthesis implant with a 37 % reduced image receptor dose are not inferior to those acquired with the standard dose.…”

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confidence: 99%

Radiation Dose Reduction in Digital Plain Radiography of the Knee after Total Knee Arthroplasty

Kloth

Tanner

Stiller

et al. 2015

Fortschr Röntgenstr

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!Purpose: To reduce radiation exposure of frequently performed radiographs of the knee in follow-up of total-knee arthroplasty ensuring accurate assessment by using objective quality control criteria. Materials and Methods: In this prospective randomized study 278 radiographs of the knee in follow-up of total-knee arthroplasty were performed with standard and 37 % reduced radiation dose. The evaluation of the plain-radiographs was conducted using the following criteria: bone-implant interface, implant-surface character, implant-implant discrimination and periarticular heterotopic ossification. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score ≥ 3 or more than 2 criteria with ≥ 2 points, the radiograph was score das "not assessable". The study was designed as non-inferioritytrial. Results: 100 % of examined radiographs were scored as assessable, hence no statistical inferiority between the examinations with standard and reduced dose could be observed. Singular assessment of the defined criteria was likewise dose-independent. Conclusion: Plain-radiography of the knee following total-knee arthroplasty can be performed with 63 % of standard dose without loss of diagnostic validity. Key points:▶ Due to the non-inferiority of digital radiographs of the knee joint after total-knee arthroplasty done with 37 % reduced image receiver dose we recommend the tested speed class of SC 800 as a new reference value for digital radiographs with this indication.

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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

Cited by 93 publications

References 24 publications

Comparison of image quality using a X-ray stereotactical whole-body system and a direct flat-panel X-ray device in examinations of the pelvis and knee

Comparison of image quality using a X-ray stereotactical whole-body system and a direct flat-panel X-ray device in examinations of the pelvis and knee

Assessment of two-dimensional (2D) and three-dimensional (3D) lower limb measurements in adults: Comparison of micro-dose and low-dose biplanar radiographs

Radiation Dose Reduction in Digital Plain Radiography of the Knee after Total Knee Arthroplasty

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