Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard

Abstract

Purpose Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk. Methods We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study. Results We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females). Conclusion There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required. Level of evidence III.

Evaluation of the cardiopulmonary size on slot-scanning full-spine radiographs

“…It has been shown that image quality of a properly acquired conventional digital radiograph exceeds that of EOS [5]. Nonetheless, the substantial radiation dose reduction which can be achieved by EOS compared to conventional whole body radiography must be also emphasized, as it has been shown that the latter results in a 5.4-fold increase in lifetime cancer risk in the paediatric population [18].…”

As fast as an X-ray: real-time magnetic resonance imaging for diagnosis of idiopathic scoliosis in children and adolescents

“…Additionally, the acquisition costs for an X-ray machine that can only be used for whole-body images are a concern [ 9 ]. Although Rose et al showed more than five times lower radiation exposure compared to standard X-rays of the spine, the advantages do not seem to justify the high costs [ 24 , 25 ].…”

Case of the False Fracture

“…Despite this, Simons et al found no significant measurement differences between EOS imaging and routine radiographs, with high intraobserver and interobserver reliability 9 . Although initial studies raised questions regarding the cost benefits of EOS scans 10 , recent research demonstrated a significant 5.4-fold increase in cancer risk with standard imaging compared with EOS whole-spine monitoring in children 11 . Although widespread adoption of EOS, particularly outside of major academic institutions, is a considerable goal yet to be attained, we anticipate progressive implementation because of its significant benefits, one of which includes the elimination of stitching errors.…”