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

Hull, Nathan C.; Binkovitz, Larry A.; Schueler, Beth A.; Kolbe, Amy B.; Larson, A. Noelle

doi:10.2214/ajr.14.14022

Cited by 16 publications

(10 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, no studies have actually examined the agreement between EOS and standard X-ray systems. In contrast to Hull's suggestion [24] , the results of the present study proved that the effect of geometrical magnification on Cobb angle measurement is insignificant. The difference in the Cobb angle measurement between imaging methods could be regarded as measurement variability rather than real error.…”

Section: Discussioncontrasting

confidence: 99%

“…Previous studies have compared the performance of EOS with CT in the measurement of scoliotic curves, and most studies reported an excellent agreement between EOS and CT in measuring Cobb angle and confirmed EOS to be a reliable and accurate imaging acquisition method for scoliosis examination [22] , [23] . It is suggested that the biplanar X-ray sources and detectors of EOS system translate simultaneously along superoinferior direction; thus, the images produced do not have geometrical magnification, contrary to conventional projection imaging systems [24] . However, no studies have actually examined the agreement between EOS and standard X-ray systems.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Chung

Ming

et al. 2018

Journal of Orthopaedic Translation

View full text Add to dashboard Cite

SummaryBackgroundComputed radiography (CR), digital radiography (DR) and biplanar radiography (EOS™ imaging system) are common imaging tools for radiographic evaluation of adolescent idiopathic scoliosis (AIS). The effect of imaging methods in relation to later-on Cobb angle measurements on radiographs is not yet quantified. The study aimed to examine the compatibility between CR, DR and EOS for scoliotic quantification by evaluating the reliability, agreement of different imaging methods, and assessing the prediction performance for EOS measurement from that of CR and DR.MethodA flexible spine phantom was used to simulate 32 different scoliotic curves ranging from 10° to 60°. Each curvature was imaged using DR, CR and EOS systems accordingly. Each of the six observers independently measured Cobb angle twice on each image at a two-week interval. Intraclass correlation coefficient (model 2 and 3), Bland-Altman plot and linear regression analysis were completed to evaluate the reliability, agreement, and the prediction of Cobb angle measurement, respectively.ResultsReliability analysis showed excellent intra-observer reliability (Intraclass correlation coefficient >0.9) for each observer and good inter-observer reliability (Intraclass correlation coefficient = 0.84 for EOS; 0.739 for CR; 0.877 for DR) for each method. Bland-Altman plots demonstrated good agreement between imaging methods without fixed or proportional bias. Excellent coefficient of determination was achieved, with 0.980 for CR versus EOS measurements, and 0.973 for DR versus EOS measurements.ConclusionsRadiographs produced by all of the three methods can provide reliable and accurate Cobb angle measurements for scoliosis assessments. None of the methods systemically underestimates or overestimates the Cobb angle measurement. Additionally, all of the evaluated methods are satisfactory in obtaining images for Cobb angle measurement in AIS. However, the 3D post-processing techniques offered by EOS should also be taken into consideration as it takes a vital role in treatment and monitoring of 3D deformity in the case of scoliosis.The translational potential of this articleIn view of the limited availability of biplanar radiography (EOS™ imaging system), computed radiography and digital radiography are demonstrated to be reliable alternatives in scoliosis monitoring as evident in the reliability, agreement and prediction of Cobb angle measurement.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Chung

Ming

et al. 2018

Journal of Orthopaedic Translation

View full text Add to dashboard Cite

show abstract

“…This could be achieved through a number of methods: viz. reducing the number of radiographs to as few as possible [ 54 ], reducing the exposed area [ 9 ] and using the optimal radiographic technique.…”

Section: Radiographymentioning

confidence: 99%

“…EOS ® has been in clinical use since 2000. It reduces radiation exposure by approximately 6 times that of conventional radiography [ 54 , 60 , 63 , 65 ]. Recently, as a result of technical advances, the microdose protocol was developed further reducing the radiation dose to patients.…”

Section: Eos ®mentioning

confidence: 99%

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

Ng¹,

Bettany‐Saltikov²

2017

TOORTHJ

View full text Add to dashboard Cite

The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis.The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.

show abstract

“…3) and increased risk of motion artifacts, especially in pediatric patients, due to a slow image acquisition process. 21 However, given that EOS appears to be equivalent to radiography for spine, hip, and chest imaging, 13,14 and putatively shunt This study has several limitations. It is retrospective and included only patients with shunted hydrocephalus due to Chiari type II malformations.…”

Section: Discussionmentioning

confidence: 90%

Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity

Monuszko

Malinzak²,

Yang

et al. 2021

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEPatients with shunted hydrocephalus often accumulate high levels of radiation over their lifetimes during evaluation of hardware integrity. Current practice involves the use of a series of conventional radiographs for this purpose. Newer low-dose EOS radiography is currently used to evaluate scoliosis but has not been explored to evaluate shunt integrity on a large scale. The goal of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate shunt tubing.METHODSA retrospective chart review was performed on 57 patients who previously had both conventional radiographs and low-dose EOS images of their cerebral shunt tubing from 2000 to 2018. Patient demographics (age, sex, type of shunt tubing, primary diagnosis) were collected. Conventional radiographic images and low-dose EOS images were independently analyzed by a neurosurgeon and neuroradiologist in three categories: image quality, delineation of shunt, and distinction of shunt compared to adjacent anatomy.RESULTSAll patients had shunted hydrocephalus due to spina bifida and Chiari type II malformation. Ratings of EOS and conventional radiographic images by both raters did not differ significantly in terms of image quality (rater 1, p = 0.499; rater 2, p = 0.578) or delineation of shunt (p = 0.107 and p = 0.256). Conventional radiographic images received significantly higher ratings than EOS on the ability to distinguish the shunt versus adjacent anatomy by rater 1 (p = 0.039), but not by rater 2 (p = 0.149). The overall score of the three categories combined was not significantly different between EOS and conventional radiography (rater 1, p = 0.818; rater 2, p = 0.186). In terms of cost, an EOS image was less costly than a conventional radiography shunt series ($236–$366 and $1300–$1547, respectively). The radiation dose was also lower for EOS images, with an effective dose of 0.086–0.140 mSv compared to approximately 1.6 mSv for a similar field of view with conventional radiography.CONCLUSIONSThe image quality of low-dose EOS radiography does not significantly differ from conventional radiography for the evaluation of cerebral shunts. In addition, EOS affords a much lower radiation dose and a lower cost.

show abstract

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

Abstract: Upright biplanar slot scanners acquire high-resolution radiographs simultaneously in two orthogonal planes with reduced radiation dose. Other advantages include a more physiologic weightbearing imaging position, improved Cobb angle measurements, and 3D modeling.

Cited by 16 publications

References 39 publications

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

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

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity

Contact Info

Product

Resources

About