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Narahashi É, Guimarães JB, Filho AGO, Nico MAC, Silva FD. Measurement of tibial slope using biplanar stereoradiography (EOS®). Skeletal Radiol 2024; 53:1091-1101. [PMID: 38051424 DOI: 10.1007/s00256-023-04528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. METHODS This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. RESULTS The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738-0.883 and 0.870-0.975). CONCLUSIONS Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.
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Affiliation(s)
- Érica Narahashi
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Flávio Duarte Silva
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
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Di Martino A, Geraci G, Brunello M, D'Agostino C, Davico G, Curreli C, Traina F, Faldini C. Hip-spine relationship: clinical evidence and biomechanical issues. Arch Orthop Trauma Surg 2024; 144:1821-1833. [PMID: 38472450 PMCID: PMC10965652 DOI: 10.1007/s00402-024-05227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
The hip-spine relationship is a critical consideration in total hip arthroplasty (THA) procedures. While THA is generally successful in patient, complications such as instability and dislocation can arise. These issues are significantly influenced by the alignment of implant components and the overall balance of the spine and pelvis, known as spinopelvic balance. Patients with alteration of those parameters, in particular rigid spines, often due to fusion surgery, face a higher risk of THA complications, with an emphasis on complications in instability, impingement and dislocation. For these reasons, over the years, computer modelling and simulation techniques have been developed to support clinicians in the different steps of surgery. The aim of the current review is to present current knowledge on hip-spine relationship to serve as a common platform of discussion among clinicians and engineers. The offered overview aims to update the reader on the main critical aspects of the issue, from both a theoretical and practical perspective, and to be a valuable introductory tool for those approaching this problem for the first time.
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Affiliation(s)
- Alberto Di Martino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Giuseppe Geraci
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Matteo Brunello
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Claudio D'Agostino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Giorgio Davico
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cristina Curreli
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Alghamdi A, Madan S, Shuweihdi F, Offiah AC. "The accuracy of the EOS imaging system to assess hip abnormalities in adolescents and adults:" a systematic review and meta-analysis. Skeletal Radiol 2024; 53:29-42. [PMID: 37338589 PMCID: PMC10661804 DOI: 10.1007/s00256-023-04351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To determine the accuracy of the EOS imaging system compared to the gold standard computed tomography (CT) scan, for the measurement of native and postoperative/prosthetic hip parameters in adolescents and adults. METHODS Medline, Cochrane Systematic Review, and Web of Science databases were searched to obtain relevant articles published between January 1964 and February 2021. All articles published in English. Inclusion and exclusion criteria were developed according to the Population, Intervention, Comparator, Outcome (PICO) framework. Three reviewers independently assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. A narrative synthesis of the articles and a meta-analysis were conducted. The heterogeneity exhibited by the effect sizes was obtained using a forest plot, the Q statistic and the I2 index. Reliability coefficients were transformed into Fisher's Z to normalise their distribution and stabilise the variances. For each meta-analysis, an effect size (average reliability coefficient) and a 95% confidence interval were calculated and presented in a forest plot. The amount of radiation dose between modalities was compared. RESULTS The search retrieved 75 articles, six of which met inclusion and exclusion criteria. The meta-analysis included five of these six studies (sample size from 20 to 90). Comparing EOS and CT, the estimated average correlation (effect size) for combined studies was significantly high (r = 0.84, 95% CI = 0.78 to 0.88, p-value < 0.001). With respect to Pearson's correlation between EOS and CT, the estimated average correlation for combined studies was significantly high (r = 0.86, 95% CI = 0.80 to 0.90, p-value < 0.001). Average radiation dose for EOS was 0.18 ± 0.05 mGy for the anteroposterior view (AP) and 0.45 ± 0.08 mGy for the lateral view; and for CT was 8.4 to 15.6 mGy. CONCLUSION The EOS imaging system has a high correlation with CT for preoperative and postoperative/prosthetic hip measurements, with considerably lower irradiation of patients.
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Affiliation(s)
- Ahmed Alghamdi
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
- Diagnostic Radiology Department, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sanjeev Madan
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
- Doncaster &, Bassetlaw Teaching Hospitals, Doncaster, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
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Yoo HJ, Choi JK, Heo YM, Moon SJ, Oh BH. Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis. J Clin Med 2023; 12:5638. [PMID: 37685705 PMCID: PMC10488862 DOI: 10.3390/jcm12175638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO.
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Affiliation(s)
| | | | | | | | - Byung-Hak Oh
- Department of Orthopedic Surgery, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea; (H.-J.Y.); (J.-K.C.); (Y.-M.H.); (S.-J.M.)
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Morimoto T, Yamamoto Y, Suzuki S, Yagi M, Kobayashi T, Mawatari M, Matsumoto M, Watanabe K. Analysis of the sacroiliac joint vacuum phenomenon in adolescent thoracic idiopathic scoliosis (Lenke types 1 and 2). Medicine (Baltimore) 2023; 102:e34487. [PMID: 37653771 PMCID: PMC10470709 DOI: 10.1097/md.0000000000034487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 09/02/2023] Open
Abstract
The sacroiliac joint (SIJ) is the largest axial joint in the human body, and the SIJ vacuum phenomenon (SIJ VP) is a common finding in computed tomography studies of the abdomen, pelvis, and lumbosacral spine in adults, with the incidence increasing with age. Adolescent idiopathic scoliosis (AIS) is an abnormal spinal curvature that appears during adolescence and places abnormal stress on the SIJs. This retrospective observational study aimed to investigate the incidence of the SIJ VP in thoracic AIS (Lenke types 1 and 2). Sixty-seven patients with AIS (age: 12-19 years) and 76 controls (age: 11-19 years) were retrospectively analyzed to investigate SIJ VP, subchondral bone cysts, and SIJ degeneration (Eno classification: type 0, no degenerative change; type 1, mild degenerative changes; type 2, substantial degenerative changes; and type 3, ankylosis). SIJ degeneration was defined as type ≥ 2. The association between SIJ VP, cysts, SIJ degeneration, and sagittal/coronal spinopelvic alignment was assessed. SIJ VP (59% vs. 35.5%, P < .01), cysts (32.8% vs. 1.3%, P < .01), and SIJ degeneration (3.2% vs. 2.6%, P = .823) differed significantly between the 2 groups. There were 0 cases of SIJ ankylosis (Eno classification type 3) in both groups. The VP was not correlated with lumbar lordosis, sacral slope, or Cobb angle. All lumbar modifier type C belonged to the VP present group, whereas none to VP absent group. Our results suggest an association between AIS and SIJ VP and SIJ cysts. SIJ VP and SIJ cysts in AIS may be caused and accelerated by abnormal mechanical stress on SIJ due to spinal deformity.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Nara Medical University, Nara, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Safety and Efficacy of Stand-Alone Bioactive Glass Injectable Putty or Granules in Posterior Vertebral Fusion for Adolescent Idiopathic and Non-Idiopathic Scoliosis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020398. [PMID: 36832526 PMCID: PMC9955925 DOI: 10.3390/children10020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Posterior spinal fusion (PSF) is the standard procedure for the treatment of severe scoliosis. PSF is a standard procedure that combines posterior instrumentation with bone grafting and/or bone substitutes to enhance fusion. The aim of this retrospective study was to evaluate and compare the post-operative safety and efficiency of stand-alone bioactive glass putty and granules in posterior spine fusion for scoliosis in a paediatric cohort. A total of 43 children and adolescents were included retrospectively. Each patient's last follow-up was performed at 24 months and included clinical and radiological evaluations. Pseudarthrosis was defined as a loss of correction measuring >10° of Cobb angle between the pre-operative and last follow-up measurements. There was no significant loss of correction between the immediate post-operative timepoint and the 24-month follow-up. There was no sign of non-union, implant displacement or rod breakage. Bioactive glass in the form of putty or granules is an easily handled biomaterial but still a newcomer on the market. This study shows that the massive use of bioactive glass in posterior fusion, when combined with proper surgical planning, hardware placement and correction, is effective in providing good clinical and radiological outcomes.
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Ries AJ, Duffy EA, Schwartz MH, Novacheck TF, Chau MM. Interobserver reliability of biplanar radiography is unaffected by clinical factors relevant to individuals at risk of pathological lower limb torsion. Gait Posture 2023; 100:126-131. [PMID: 36521256 DOI: 10.1016/j.gaitpost.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/08/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assessments of lower limb torsion are ubiquitous in clinical gait analysis practice as pathologic lower limb rotational deformity may contribute to gait abnormalities, anterior knee pain, as well as other debilitating conditions. Understandably, the overall utility of any torsional assessment is dependent on the measurement method's intrinsic accuracy, precision, and robustness to clinical interference factors. Recently, biplanar radiography (BPR) measurements of torsion have been shown to be both accurate and precise, but the robustness of BPR to potential interference factors is unknown. RESEARCH QUESTION How robust are BPR lower limb torsional assessments to six potential interference factors: amount of torsion, skeletal maturity, radiograph quality, prior osteotomy, presence of implants, and observer training background and experience? METHODS In this retrospective cohort study, four observers of diverse backgrounds and experience generated digital 3D reconstructions of 44 lower limbs using BPR images obtained during standard of care visits (age range 7-35 years). From each reconstruction, four lower limb torsional parameters were computed: femoral torsion, femorotibial rotation, tibial torsion, and transmalleolar axis equivalent. The mean absolute deviation (MAD) of each torsional parameter - calculated across the four observers - was used as the measure of reliability and tested against all interference factors. RESULTS Results demonstrated that the average MAD was 2.1 degrees for femoral torsion, 3.0 degrees for transmalleolar axis equivalent, 3.8 degrees for femorotibial rotation, and 4.7 degrees for tibial torsion. None of the six potential interference factors were found to systematically influence BPR reliability across all four torsional parameters. Of the factors found to statistically influence one or more torsional parameter, none affected MAD values to a clinically meaningful extent. SIGNIFICANCE In addition to being accurate and precise, BPR appears to be robust to several clinical factors relevant to children and young adults with or at risk for pathological lower limb torsion.
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Affiliation(s)
- Andrew J Ries
- Gillette Children's Specialty Healthcare, St. Paul, MN 55101, USA.
| | | | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN 55101, USA; University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, MN 55455, USA
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, St. Paul, MN 55101, USA; University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, MN 55455, USA
| | - Michael M Chau
- University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, MN 55455, USA
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Skaggs KF, Bainton NM, Boby AZ, Rymond CC, Fields MW, Roye BD, Vitale MG. Reliability of Preoperative Supine Versus Bending Radiographs in Estimating the Structural Nature of Curves in EOS. J Pediatr Orthop 2023; 43:70-75. [PMID: 36607916 DOI: 10.1097/bpo.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The study sought to evaluate the utility of a single supine radiograph in determining curve flexibility in early-onset scoliosis (EOS) patients. METHODS EOS patients with upright (standing/seated), supine, and side-bending radiographs who underwent spinal deformity surgery were identified. Coronal parameters included: proximal thoracic (PT) curve, main thoracic (MT) curve, and thoracolumbar/lumbar (TL/L) curve. Each radiograph was measured twice by 2 different raters. Correlation coefficients were utilized to investigate associations between the different radiographs. Interrater Correlation Coefficient (ICC) assessed intrarater and interrater reliability. RESULTS Thirty-seven EOS patients were identified (age at diagnosis: 7.0±2.9 y, preoperative age: 13.0±2.9 y; 73% female; etiologies: 54% idiopathic, 30% syndromic, and 16% neuromuscular). Supine PT and MT curve measurements were highly associated with corresponding side-bending measurements (PT: r=0.75, P<0.001; MT: r=0.80, P<0.001), and TL/L curves were very highly associated (TL/L: r=0.92, P<0.001). The mean absolute differences between supine and side-bending measurements were PT: 11.3±7.8 degrees, MT: 14.8±8.3 degrees, and TL/L: 16.2±7.6 degrees, where the side-bending was on average smaller than the supine measurement. The intrarater reliabilities were excellent, with an ICC ranging from 0.93 to 0.96 for side-bending films and 0.94 to 0.97 for supine films. The interrater reliability was excellent with ICC value of 0.88 for side-bending films and 0.93 for supine films. CONCLUSIONS A single, preoperative supine radiograph was highly predictive of side-bending radiographs in patients with EOS. Supine curves measured an average of 15 degrees larger than bending curves in the MT and TL/L region. A single supine film may eliminate the need for effort-related, dual side-bending radiographs. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
- Kira F Skaggs
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Nicole M Bainton
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Afrain Z Boby
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Christina C Rymond
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Michael W Fields
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Prevalence of benign bone lesions of the lower extremity in the pediatric spinal disorders: a whole-body imaging study. J Pediatr Orthop B 2022; 31:583-590. [PMID: 35102057 DOI: 10.1097/bpb.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
There is a paucity of knowledge about benign bone lesions. The advances in imaging methods can screen bone lesions incidentally, and missing information can be provided. The aim of the study is to collect information about the prevalence and natural history of benign bone lesions with the use of whole-body biplanar slot-scanning imaging (EOS). EOS images acquired between 2015 and 2020 were retrospectively analyzed. Anatomical locations of lesions, number of lesions with polyostotic involvement and radiographic features of each were recorded. Fibrous lesions were further categorized according to the transition stages. The natural course was noted as remained in the same stage, progressed and disappeared during follow-up. A total of 1944 EOS images of 1378 (936 women and 442 men) patients were analyzed. The mean age was 12.3 (5-18) years. Bone lesions of the lower extremities were found in 278 scans (14.3%) of 196 (139 women and 57 men) patients (14.2%). Monostotic lesions were observed in 172 patients, and 24 had polyostotic lesions. The prevalence of lesions was 10.5%, 1.8%, 1.7%, 1.7% and 1.4‰ for fibrous cortical defect (FCD), nonossifying fibroma (NOF), osteochondroma, bone island and simple bone cyst, respectively. Among 145 FCDs, 55.2% of the lesions were stage A, 27.6% were stage B, 9.6% were stage C and 7.5% were stage D. EOS images acquired predominantly for spinal pathologies revealed a prevalence of 14% of benign bone tumors in the lower extremities. With the developments in imaging methods, the probability of encountering incidental lesion increases, and information about bone pathologies can be gathered.
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Accuracy of biplanar linear radiography versus conventional radiographs when used for lower limb and implant measurements. Arch Orthop Trauma Surg 2022; 142:735-745. [PMID: 33386975 DOI: 10.1007/s00402-020-03700-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The current standard of care for measuring lower extremity length and angular discrepancies is using a full-length standing anteroposterior radiograph. However, there has been increasing interest to use biplanar linear EOS imaging as an alternative. This study aims to compare lower extremity length and implant measurements between biplanar linear and conventional radiographs. MATERIALS AND METHODS In this 5-year retrospective study, all patients who had a standing full-length anteroposterior and biplanar linear radiographs (EOS®) that include the lower extremities done within one year of each other were included. Patients who underwent surgery in between the imaging, underwent surgeries that could result in graduated length or angulated corrections and inadequate exposure of the lower extremity were excluded. Four radiographic segments were measured to assess lower limb alignment and length measurements. Height and width measurements of implants were performed for patients who had implants in both imaging. RESULTS When comparing imaging and actual implant dimensions, biplanar linear radiographs were accurate in measuring actual implant height (median difference = - 0.14 cm, p = 0.66), and width (median difference = - 0.13 cm, p = 0.71). However, conventional radiographs were inaccurate in measuring actual implant height (median difference = 0.19 cm, p = 0.01) and width (median difference = 0.61 cm, p < 0.01). When comparing conventional and biplanar linear radiographs, there was statistically significant difference in all measurements. This includes anatomical femoral length (median difference = 3.53 cm, p < 0.01), mechanical femoral length (median difference = 3.89 cm, p < 0.01), anatomical tibial length (median difference = 2.34 cm, p < 0.01) and mechanical tibial length (median difference = 2.20 cm, p < 0.01). CONCLUSION First, there is a significant difference in the lower extremity length when comparing conventional and biplanar linear radiographs. Second, biplanar linear radiographs are found to be accurate while conventional radiographs are not as accurate in implant measurements of length and width in the lower extremity.
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Park KR, Lee JH, Kim DS, Ryu H, Kim J, Yon CJ, Lee SW. The Comparison of Lower Extremity Length and Angle between Computed Radiography-Based Teleoroentgenogram and EOS ® Imaging System. Diagnostics (Basel) 2022; 12:diagnostics12051052. [PMID: 35626207 PMCID: PMC9139399 DOI: 10.3390/diagnostics12051052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The differences between computed radiography-based teleoroentgenograms (CR-based teleoroentgenograms) and an EOS® imaging system were evaluated by measuring lower extremity lengths and alignments. Materials and methods: The leg length [L], femur length [F], tibia length [T], and hip−knee−ankle (HKA) angle were measured in 101 patients with lower extremity disease by a CR-based teleoroentgenogram with computed radiography and an EOS®. The additive length of the femoral and tibial segments (F + T) was determined by adding the two length values. Then, the differences among all five parameters between the two techniques were analyzed. The magnification (mm) was calculated by subtracting the length measurements on the EOS® from those in the scanogram. Furthermore, the magnification percentage (%) was calculated by dividing the magnification with the measurements on the EOS®. Results: The magnification errors (mean ± standard deviation), when comparing both right and left sides, were 7.80 ± 1.41%, 7.3 ± 6.01%, 5.16 ± 1.25%, and 6.45 ± 0.94% for L, F, T, and F + T, respectively. For limb length, the CR-based teleoroentgenogram had an average magnification of 6.8% (range, 5.2 to 7.8%) compared to the EOS® imaging. The two groups displayed a statistical difference (p < 0.01), except for the HKA angle. Conclusions: The CR-based teleoroentgenogram had a magnification of about 6.8% compared to the EOS® imaging system in evaluating lower extremity length. Therefore, more attention must be given to CR-based teleoroentgenograms to correct angular deformities.
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Affiliation(s)
- Kwang-Rak Park
- Department of Anatomy, Keimyung University College of Medicine, Daegu 42601, Korea; (K.-R.P.); (J.-H.L.)
| | - Jae-Ho Lee
- Department of Anatomy, Keimyung University College of Medicine, Daegu 42601, Korea; (K.-R.P.); (J.-H.L.)
| | | | - Ho Ryu
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu 42601, Korea;
| | - Jaeho Kim
- Dongsan Medical Center, Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu 42601, Korea; (J.K.); (C.-J.Y.)
| | - Chang-Jin Yon
- Dongsan Medical Center, Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu 42601, Korea; (J.K.); (C.-J.Y.)
| | - Si-Wook Lee
- Dongsan Medical Center, Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu 42601, Korea; (J.K.); (C.-J.Y.)
- Correspondence: ; Tel.: +82-53-258-4771
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Zuckerman SL, Segar AH, Cerpa M, Chanbour H, Sardar ZM, Lenke LG. Three-Dimensional Assessment of Vertebral Derotation in Adolescent Idiopathic Scoliosis: Review of a Surgical Technique and Its Success in Achieving Derotation in the Instrumented and Uninstrumented Spine. Oper Neurosurg (Hagerstown) 2022; 22:380-386. [PMID: 35383691 DOI: 10.1227/ons.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) imaging represents a novel way to assess surgical derotation maneuvers in adolescent idiopathic scoliosis (AIS). OBJECTIVE To assess the following in patients with AIS undergoing derotation surgery with Lenke type 1/2 curves using 3D imaging: (1) the primary outcome of thoracic apical vertebral rotation (T-AVR) and (2) secondary outcomes of thoracic kyphosis (TK), lumbar AVR (L-AVR), and rotation of each thoracic/lumbar vertebrae. METHODS A retrospective, pilot study of type 1/2 AIS patients from 2017 to 2018 was performed. All patients received posterior pedicle screw/rod constructs with consistent direct vertebral derotational maneuvers and received full length SterEOS imaging with 3D reconstruction. The primary outcome of interest was T-AVR. Secondary outcomes included TK, L-AVR, and rotation at each thoracic/lumbar vertebrae. RESULTS Fifteen patients (mean age 15.7 ± 1.2 years, 67.0% female) were studied. The mean preoperative/postoperative Cobb angle of the major curve was 51.8° ± 14.9° (range 39.8-62.0) and 11.0° ± 5.1° (range 3.7-20.7). Mean level fused was 10.5 ± 1.2. The primary outcome of T-AVR showed significant improvement (13.8° ± 12.5° vs 9.2° ± 8.6°, P = .015) after surgery, along with secondary outcome of TK (T1-12/T4-12, P = .008/.027). Significant spontaneous rotational improvement was seen in L-AVR (P = .016). Significant improvement was also seen in 11 of 17 (64.7%) individual vertebrae (T3-8/T11-L3) (P < .05). CONCLUSION In Lenke Type 1/2 AIS patients undergoing surgical derotation and fusion, 3D imaging techniques captured improvements in rotation. Significant postoperative improvement was seen in T-AVR, TK, L-AVR, and rotation of the individual vertebrae T3-8/T11-L3. These pilot results warrant the study of 3D imaging in all patients with AIS and other scoliosis populations.
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Affiliation(s)
- Scott L Zuckerman
- Department Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anand H Segar
- Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, New York, USA
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, New York, USA
| | - Hani Chanbour
- Department Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zeeshan M Sardar
- Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, New York, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, New York, USA
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Three-dimensional reconstruction of In Vivo human lumbar spine from biplanar radiographs. Comput Med Imaging Graph 2021; 96:102011. [PMID: 35007843 DOI: 10.1016/j.compmedimag.2021.102011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
We present a method for three dimensional (3D) reconstruction of in vivo human lumbar spine from biplanar radiographs with comparable results to Computerised Tomography (CT) scans or Magnetic Resonance Imaging (MRI) models. In this work, we used uncalibrated radiographs to reconstruct the 3D vertebrae and a priori information stored in an Active Shape Model (ASM) that is constructed using the Spherical Demons Algorithm. The method is semi-automatic as bounding boxes are required to delimit the positions of the vertebrae on biplanar radiographs of a patient. Optimisation is based on comparisons between simulated and actual radiographs. Finally, we compare the results to the models generated from MRI and CT scans. The results show the feasibility of generating personalised models of patients from biplanar radiographs.
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Walter C, Schaefer JF, Tsiflikas I. Reduction of radiation exposure in scoliosis monitoring using flat detector and pulsed fluoroscopy technology. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A new flat detector and pulsed fluoroscopy technology is available to further reduce radiation exposure in radiological monitoring during scoliosis treatment in children and adolescents. The aim of this study is to compare different settings of the system (opening area(OA) and image quality settings (IQS)) in order to find the optimal parameters with high image quality and the lowest possible radiation exposure. Therefore, we examined four cadaver spines (T1 to sacrum) with the flat detector technique using digital pulsed fluoroscopy and simulated the abdominal soft tissues. The images were merged and evaluated by three different investigators using an established scoring system. For comparison, we used digital radiography images of the cadaver spines. The values for the DAP increased from the small OA (33% ; 0.56 µGy·m²) to the maximum OA (100% ; 0.82 µGy·m²) by 45% (p = .003) and from the low image quality setting (0.57 µGy·m²) to the high setting (0.84 µGy·m²) by 48% (p = .028). Despite the low DAP, the setting 33% OA achieved the best point values for image quality, therefore this setting is clearly preferred. Using a digital fluoroscopy system allows a significant reduction of radiation exposure by a factor of 7.5 (3.88µGy·m² to 0.5µGy·m²) compared to slot- scanning x-ray (EOS). Due to this success, the flat detector and pulsed fluoroscopy technology can be an alternative to established methods such as X-ray and EOS in clinical use.
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15
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Abstract
X-linked hypophosphatemia (XLH) is the most common form of inheritable rickets. The disease is caused principally by PHEX mutations leading to increased concentrations of circulating intact FGF23, hence renal phosphate wasting, hypophosphatemia, and decreased circulating levels of 1,25(OH)2 vitamin D. The chronic hypophosphatemia leads to rickets and osteomalacia through a combination of mechanisms, including a lack of endochondral ossification and impaired mineralization. Imaging has a major role in determining the diagnosis of rickets and its cause, detecting complications as early as possible, and helping in treatment monitoring.
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Pang H, Wong YS, Yip BHK, Hung ALH, Chu WCW, Lai KKL, Zheng YP, Chung TWH, Sharma G, Cheng JCY, Lam TP. Using Ultrasound to Screen for Scoliosis to Reduce Unnecessary Radiographic Radiation: A Prospective Diagnostic Accuracy Study on 442 Schoolchildren. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2598-2607. [PMID: 34210559 DOI: 10.1016/j.ultrasmedbio.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children and adolescents. School scoliosis screening programs in Hong Kong follow the protocol of referring children screened positive with a scoliometer and Moiré topography for confirmatory standard radiography. Despite being highly sensitive (88%) in detecting those who require specialist referral, the screening program was found to have a false-positive rate >50%, which could lead to unnecessary X-ray radiation. Radiation-free ultrasound has been reported to be valid and reliable for quantitative assessment of curve severity in scoliosis patients. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography. Our study recruited 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6°. The sensitivity and specificity of ultrasound in predicting the correct referral status, confirmed by X-ray, were 92.3% and 51.6%, with positive and negative predictive values of 29.0% and 96.9%, respectively. Receiver operating characteristic curve analysis revealed area under the curve values of 0.735 for ultrasound alone and 0.832 for ultrasound in combination with measurement of angle of trunk rotation. The finding supports the accuracy of using ultrasound to determine referral status, which could result in a >50% reduction of unnecessary radiation for children undergoing scoliosis screening.
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Affiliation(s)
- Henry Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Yi-Shun Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alec Lik-Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | | | - Geeta Sharma
- Student Health Service, Department of Health, Hong Kong SAR
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR.
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Pacult MA, Walker CT, Godzik J, Turner JD, Uribe JS. Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms. Oper Neurosurg (Hagerstown) 2021; 21:S39-S45. [PMID: 34128066 DOI: 10.1093/ons/opaa324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk. Several mitigating techniques have arisen in recent years, ranging from lead protection to radiation-reducing protocols, although each technique has limits. A hitherto-problematic barrier has been the fact that efforts to diminish radiation emission come at the cost of reduced image quality. OBJECTIVE To describe new ultra-low radiation imaging modalities that have the potential to drastically reduce radiation risk and minimize unacceptable adverse effects. METHODS A literature review was performed of articles and studies that used either of 2 ultra-low radiation imaging modalities, the EOS system (EOS-Imaging S.A., Paris, France) and LessRay (NuVasive, San Diego, CA). RESULTS Both ultra-low radiation imaging modalities reduce radiation exposure in the preoperative and perioperative settings. EOS provides 3-dimensional reconstructive capability, and LessRay offers intraoperative tools that facilitate spinal localization and proper visual alignment of the spine. CONCLUSION These novel radiation-reducing technologies diminish patient and surgeon exposure, aid the surgeon in preoperative planning, and streamline intraoperative workflow.
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Affiliation(s)
- Mark A Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Jarrett DY, Ecklund K. EOS Imaging of Scoliosis, Leg Length Discrepancy and Alignment. Semin Roentgenol 2021; 56:228-244. [PMID: 34281677 DOI: 10.1053/j.ro.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Delma Y Jarrett
- Assistant Professor of Clinical Radiology, Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
| | - Kirsten Ecklund
- Assistant Professor of Radiology, Pediatric Radiology Division Chief, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Orfeuvre B, Tonetti J, Kerschbaumer G, Barthelemy R, Moreau-Gaudry A, Boudissa M. EOS stereographic assessment of femoral shaft malunion after intramedullary nailing. A prospective series of 48 patients at 9 months' follow-up. Orthop Traumatol Surg Res 2021; 107:102805. [PMID: 33434691 DOI: 10.1016/j.otsr.2021.102805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/14/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of the present study was to assess femoral shaft malunion following anterograde intramedullary nailing, using low-dose EOS stereoradiography. The study hypothesis was that our surgical technique is associated with radiological rotation disorder rates equivalent to those reported in the literature. METHODS All patients with unilateral femoral shaft fracture treated by anterograde nailing between January 2014 and December 2016 and followed up in our structure were included in a single-center prospective study. The main endpoint was≥15° transverse malrotation compared to the contralateral side as measured on EOS stereoradiography. Correlations between malrotation and Harris Hip and SF12 functional scores were assessed, as were risk factors for onset of shaft malunion in rotation. Forty-eight patients with a mean age of 31.4 years were analyzed at a mean 9.3 months' follow-up. RESULTS Stereoradiographic malrotation was found in 29.2% of patients. Mean anteversion was 18.5±13.8°. In 2.1% of patients, symptomatic rotation disorder required revision surgery. No correlations emerged between transverse malrotation and functional scores (p>0.05). Risk factors for malrotation comprised multi-site fracture (p=0.04), surgeon's inexperience (p=0.04), and open reduction (p=0.01). CONCLUSION The present radiologic malrotation rate was comparable to those reported in the literature, using the EOS stereoradiographic system, which provides precise assessment of rotation disorder following closed nailing of femoral shaft fracture. LEVEL OF EVIDENCE III; prospective study without control group.
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Affiliation(s)
- Benoît Orfeuvre
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France.
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Renaud Barthelemy
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Alexandre Moreau-Gaudry
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
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Abstract
BACKGROUND Biplanar digital slot scanning technology has become the standard of care in the treatment of scoliosis. Yet, the amount of distortion and reproducibility of this type of imaging modality has yet to be fully investigated. In our paper "Image distortion in biplanar slot scanning: part 1 patient-specific factors" we found that there was potentially clinically impactful interimage distortion. The purpose of this study was to evaluate the degree to which this image distortion was secondary to the image acquisition process. METHODS Four 25 mm radio-opaque markers were placed at C3, T1, T12, and L5 on a full-length skeleton model. The skeleton was imaged in 10 different positions within the scanner. Five posteroanterior and 5 lateral images were obtained in each position. Two orthopaedic attending physicians and 3 orthopaedic resident physicians measured the markers for a total of 3200 measurements. Intraclass correlation coefficients (ICCs) and 95% confidence intervals were used to examine image distortion. RESULTS Average marker size was 24.77, with a standard error of measurement of 0.00493. Image distortion and standard error of measurement accounted for ∼0.5% to 1.5% of total the measurement. Overall, there was good reliability and consistency when looking at markers in different views (ICC 0.790), planes, and locations within the image. Horizontal measurements were found to be more consistent and have better reliability (ICC 0.881) than vertical measurements (ICC 0.386). Position within the scanner had minimal impact on the accuracy of the measurements. CONCLUSIONS This study demonstrates that there is minimal error due to image acquisition and measurement when using a biplanar slot scanner. Biplanar slot scanning technology tended to underestimate the size of the marker; however, the least accurate measurements only erred by 1.5% from the true length. This indicates that unlike traditional radiographs the sources of error in biplanar slot scanning images are not due to parallax and are likely due to patient-specific factors and rather than the technology itself.
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Hand Bone Age Radiography: Comparison Between Slot-scanning and Conventional Techniques. J Pediatr Orthop 2021; 41:e167-e173. [PMID: 33165269 DOI: 10.1097/bpo.0000000000001710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Determination and longitudinal monitoring of progressive skeletal maturity are essential in the management of children with scoliosis. Although different methods for determining skeletal maturity exists, the most widely practiced method relies on the ossification pattern of the bones of the hand and wrist, which is traditionally acquired using conventional techniques and after the acquisition of the spine using the low-dose slot-scanning technique. Whereas the existing published literature has published promising results on the use of the slot-scanning technique to acquire these hand and wrist radiographs, image quality and radiation dose have not been systematically compared between these techniques. Thus, the objective of our study is to compare image quality, interpretation reliability, and radiation dose of hand bone age radiographs between slot-scanning and conventional techniques using age- and sex-matched children. METHODS This retrospective study included children who underwent hand radiographs using slot-scanning between October 1, 2019 and December 31, 2019; and matched children who underwent conventional radiography. Blinded to technique, 5 readers reviewed all radiographs after randomization to rate image quality and to determine bone age using the Greulich and Pyle classification. Dose area product was recorded. Mann-Whitney and t tests were used to compare variables between techniques and intraclass correlation (ICC) to determine observer agreement. RESULTS Our study cohort of 194 children (128 girls, 66 boys; mean age: 13.7±2.3 y) included 97 slot-scanning and 97 conventional radiographs. One (1%) slot-scanning and no conventional radiograph was rated poor in image quality. There was almost perfect interpretation reliability with slot-scanning with high interobserver (ICC=0.948) and intraobserver (ICC=0.996) agreements, comparable with conventional radiographs (ICCs=0.919 and 0.996, respectively). Dose area product (n=158) was lower (P<0.002) with slot-scanning than with conventional techniques. CONCLUSION Almost perfect interobserver reliability and intraobserver reproducibility with slot-scanning radiographs (performed using significantly lower radiation doses) suggest that this technique for hand bone age determination can be a reliable adjunct to scoliosis monitoring. LEVEL OF EVIDENCE Level III.
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Raza M, Murphy D, Gelfer Y. The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review. EFORT Open Rev 2021; 6:130-138. [PMID: 33828856 PMCID: PMC8022016 DOI: 10.1302/2058-5241.6.200092] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Three-dimensional (3D) printing technology is increasingly being utilized in various surgical specialities. In paediatric orthopaedics it has been applied in the pre-operative and intra-operative stages, allowing complex deformities to be replicated and patient-specific instrumentation to be used. This systematic review analyses the literature on the effect of 3D printing on paediatric orthopaedic osteotomy outcomes.A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the use of 3D printing technology in orthopaedic osteotomy procedures in children (aged ≤ 16 years) were included. Spinal and bone tumour surgery were excluded. Data extracted included demographics, disease pathology, target bone, type of technology, imaging modality used, qualitative/quantitative outcomes and follow-up. Articles were further categorized as either 'pre-operative' or 'intra-operative' applications of the technology.Twenty-two articles fitting the inclusion criteria were included. The reported studies included 212 patients. There were five articles of level of evidence 3 and 17 level 4.A large variety of outcomes were reported with the most commonly used being operating time, fluoroscopic exposure and intra-operative blood loss.A significant difference in operative time, fluoroscopic exposure, blood loss and angular correction was found in the 'intra-operative' application group. No significant difference was found in the 'pre-operative' category.Despite a relatively low evidence base pool of studies, our aggregate data demonstrate a benefit of 3D printing technology in various deformity correction applications, especially when used in the 'intra-operative' setting. Further research including paediatric-specific core outcomes is required to determine the potential benefit of this novel addition. Cite this article: EFORT Open Rev 2021;6:130-138. DOI: 10.1302/2058-5241.6.200092.
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Affiliation(s)
- Mohsen Raza
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel Murphy
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Yael Gelfer
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.,St George's, University of London, London, UK
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Loughenbury PR, Gentles SL, Murphy EJ, Tomlinson JE, Borse VH, Dunsmuir RA, Gummerson NW, Millner PA, Rao AS, Rowbotham E, Khan AL. Estimated cumulative X-ray exposure and additional cancer risk during the evaluation and treatment of scoliosis in children and young people requiring surgery. Spine Deform 2021; 9:949-954. [PMID: 33660241 PMCID: PMC8270816 DOI: 10.1007/s43390-021-00314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/14/2021] [Indexed: 10/29/2022]
Abstract
INTRODUCTION Clinicians and patients must weigh the benefits of radiological imaging against the risks of radiation exposure in the diagnosis and treatment of scoliosis. This report aims to estimate the cumulative absorbed and equivalent dose of radiation in patients undergoing surgical treatment for scoliosis, and to present this as an estimated risk of cancer compared to background radiation levels. METHODS Retrospective review of estimated absorbed dose on the Computerised Radiology Information System (CRIS®). Patients undergoing surgical correction of scoliosis (age ≤ 25) from August 2010 to August 2015 investigated. Estimated absorbed dose [milligrays (mGy)] recorded. Pedicle screws inserted using image intensification. Equivalent dose [millisieverts (mSv)] and additional cancer risk calculated from the National Research Council document 'Health risks from exposure to low levels of ionising radiation' (2006). RESULTS 271 patients identified. Mean age 15 (range 2-25). Mean total absorbed dose 2136 mGy [standard deviation (SD) 1700 mGy]. Mean number of plain spine radiographs was 8 (SD 3) with total 1884 mGy exposure (SD 1609 mGy). Additional dose provided by CT (mean 0.17 episodes), plain chest and abdominal radiographs and image intensification. Mean number of image intensification episodes was 1.1 with mean estimated exposure 180 mGy (SD 238 mGy). Image intensification accounted for 8% of the estimated absorbed dose during treatment. Estimated mean effective dose delivered was 20.952 mSv equating to an additional cancer risk of 0.27-0.45%. CONCLUSION Additional cancer risk from cumulative imaging is small and equivalent to approximately 8 years of natural background radiation. Use of image intensification for pedicle screw insertion is a minor contribution (8%) to the total patient dose.
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Affiliation(s)
- P. R. Loughenbury
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - S. L. Gentles
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - E. J. Murphy
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - J. E. Tomlinson
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - V. H. Borse
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - R. A. Dunsmuir
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - N. W. Gummerson
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - P. A. Millner
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - A. S. Rao
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - E. Rowbotham
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
| | - A. L. Khan
- grid.415967.80000 0000 9965 1030Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX UK
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Brooks JT, Bomar JD, Jeffords ME, Farnsworth CL, Pennock AT, Upasani VV. Reliability of Low-dose Biplanar Radiography in Assessing Pediatric Torsional Pathology. J Pediatr Orthop 2021; 41:33-39. [PMID: 33055518 DOI: 10.1097/bpo.0000000000001700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low-dose biplanar radiographs (LDBRs) significantly reduce ionizing radiation exposure and may be of use in evaluating lower extremity torsion in children. In this study, we evaluated how well femoral and tibial torsional profiles obtained by LDBR correspond with 3-dimensional (3D) computed tomography (CT) and magnetic resonance axial imaging (MRI) in pediatric patients with suspected rotational abnormalities. METHODS Patients who had both LDBR and CT/MRI studies performed for suspected lower extremity rotational deformities were included. Unlike previous publications, this study focused on patients with lower extremity torsional pathology, and bilateral lower extremities of 17 patients were included. CT/MRI torsion was measured using the Reikerås method, after conversion to 3D reconstructions. The LDBRs were deidentified and sent to the software division of EOS imaging, who created 3D reconstructions and evaluated each reconstruction for the torsional quantification of the femurs and tibiae. These imaging modalities were compared using correlation statistics and Bland-Altman analyses. RESULTS The mean age of the cohort was 12.1±1.7 years old. Torsional values of the femur were significantly lower in LDBRs versus 3D CT/MRIs at 17.7±15.1 and 23.3±17.3, respectively (P=0.001). Torsional values of the tibia were similar in LDBRs versus 3D CT/MRIs at 23.6±10.6 and 25.3±11.2, respectively (P=0.503). There was a good intermodality agreement between LDBR and 3D CT/MRI torsional values in the femur (intraclass correlation coefficient=0.807) and tibia (intraclass correlation coefficient=0.768). Bland-Altman analyses showed a fixed bias with a mean difference of -5.6±8.8 degrees between femoral torsion measurements in LDBRs versus 3D CT/MRIs (P=0.001); 15% (5/34) of femurs had a clinically significant measurement discrepancy. Fixed bias for LDBR measurements compared with 3D CT/MRIs for the tibia was not observed (P=0.193), however, 12% (4/34) of tibias had a clinically significant measurement discrepancy. CONCLUSION Although we found strong correlations between torsional values of the femur and tibia measured from LDBRs and 3D CT/MRIs, torsional values of the femur produced from LDBRs were significantly lower than values obtained from 3D CT/MRIs with some notable outliers. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jaysson T Brooks
- Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
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Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat 2020; 237:811-826. [PMID: 32579722 PMCID: PMC7542196 DOI: 10.1111/joa.13249] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Differences in FNA affect the biomechanics of the hip, through alterations in factors such as moment arm lengths and joint loading. Altered gait associated with differences in FNA may also contribute to the development of a wide range of skeletal disorders including osteoarthritis. FNA varies by up to 30° within apparently healthy adults. FNA increases substantially during gestation and thereafter decreases steadily until maturity. There is some evidence of a further decrease at a much lower rate during adulthood into old age, but the mechanisms behind it have never been studied. Development of FNA appears to be strongly influenced by mechanical forces experienced during everyday movements. This is evidenced by large differences in FNA in groups where movement is impaired, such as children born breech or individuals with neuromuscular conditions such as cerebral palsy. Several methods can be used to assess FNA, which may yield different values by up to 20° in the same participant. While MRI and CT are used clinically, limitations such as their cost, scanning time and exposure to ionising radiation limit their applicability in longitudinal and population studies, particularly in children. More broadly, applicable measures such as ultrasound and functional tests exist, but they are limited by poor reliability and validity. These issues highlight the need for a valid and reliable universally accepted method. Treatment for clinically problematic FNA is usually de-rotational osteotomy; passive, non-operative methods do not have any effect. Despite observational evidence for the effects of physical activity on FNA development, the efficacy of targeted physical activity remains unexplored. The aim of this review is to describe the biomechanical and clinical consequences of FNA, factors influencing FNA and the strengths and weaknesses of different methods used to assess FNA.
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Affiliation(s)
- Matteo Scorcelletti
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Neil D. Reeves
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Jörn Rittweger
- Institute of Aerospace MedicineGerman Aerospace Center (DLR)CologneGermany
- Department of Paediatrics and Adolescent MedicineUniversity of CologneCologneGermany
| | - Alex Ireland
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
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Yeung KH, Man GCW, Lam TP, Ng BKW, Cheng JCY, Chu WCW. Accuracy on the preoperative assessment of patients with adolescent idiopathic scoliosis using biplanar low-dose stereoradiography: a comparison with computed tomography. BMC Musculoskelet Disord 2020; 21:558. [PMID: 32811481 PMCID: PMC7433123 DOI: 10.1186/s12891-020-03561-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 01/26/2023] Open
Abstract
Background Although computed tomography (CT) is commonly used to diagnose the scoliotic spine in patients with adolescent idiopathic scoliosis (AIS) preoperatively, it is limited by the high radiation and prone scanning position. Recently, a new biplanar stereoradiography (EOS) was used to image the scoliotic spine in an upright posture with significantly less radiation in non-severe AIS subjects. However, its reliability to assess preoperative AIS patients remains unreported. Hence, the purpose of this study is to compare the scoliotic curvature between prone (CT) and upright positions (EOS) in preoperative AIS patients. Methods Thirty-three pre-operative AIS patients (mean age:18.4 ± 4.2) were recruited. EOS was used to scan the whole thoracic spine at upright position. Whereas on the same day, a conventional CT scan was used to evaluate the spine in prone position. The three-dimensional reconstruction of EOS and CT of the spine were then generated. Using previous validated techniques, multiple scoliotic parameters in both modalities were determined. The agreement between the two modalities was compared using the Bland-Altman test, whereas the correlation was assessed by the intraclass correlation coefficient (ICC). Results The mean ICC (prone and upright) of intra-rater/inter-rater reliabilities for the measured parameters were 0.985,0.961/0.969,0.903, respectively. Thoracic Cobb angles, intervertebral wedging and lumbar lordosis correlated significantly between upright EOS imaging radiographs (62.9 ± 9.3°,6.4 ± 2.9° and 48.8 ± 12.4°) and prone CT (47.3 ± 10.0°,5.8 ± 2.7° and 27.9 ± 11.4°; P < 0.001). The apical vertebral wedging and apical intervertebral disc wedging showed a good correlation among the two modalities (upright, 6.5 ± 3.5° and 6.4 ± 2.9°; prone, 6.5 ± 3.6° and 5.8 ± 2.7°; R2 ≥ 0.94; P < 0.01). Similarly, there was significant correlation in apical intervertebral rotation (R2 = 0.834; P < 0.01) between the prone CT (3.4 ± 3.0°) and upright EOS (3.8 ± 3.2°). In addition, the Cobb angle was significantly larger in upright EOS (62.9 ± 9.3°) than in prone CT (47.3 ± 10.0°, P < 0.01) position. There was significant underestimation on scoliotic severity in the prone position when compared with upright position. Conclusions Importantly, the image acquisition and reconstruction from EOS can better provide accurate three-dimensional spinal representations of the scoliotic curvature in preoperative AIS patients. Moreover, our findings suggested that scoliotic curvatures in preoperative AIS patients can be largely represented by both imaging modalities despite the difference in body positioning.
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Affiliation(s)
- Kwong Hang Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gene Chi Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bobby Kin Wah Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Hau MYT, Menon DK, Chan RJN, Chung KY, Chau WW, Ho KW. Two-dimensional/three-dimensional EOS™ imaging is reliable and comparable to traditional X-ray imaging assessment of knee osteoarthritis aiding surgical management. Knee 2020; 27:970-979. [PMID: 32171627 DOI: 10.1016/j.knee.2020.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND X-ray imaging is the gold standard for assessing lower limb conditions and preoperative planning. A novel low-radiation-dose EOS™ imaging system enables full-length weight-bearing imaging in one session and three-dimensional (3D) reconstruction. Thus, it can improve assessment of limb deformities, preoperative planning and follow-up with lower radiation exposure. The objective of this study was to measure lower limbs from EOS™ images to determine its accuracy and reproducibility in comparison with long-leg X-ray images. METHODS Over a one-year period, twenty patients (forty lower limbs) with knee osteoarthritis were recruited from clinic. Thirty-five (five excluded due to knee prosthesis) two-dimensional- (2D) EOS™, 3D EOS™ and X-ray images were measured independently by four observers, measuring lower limb angles and lengths. On average, twelve weeks later, observers repeated measurements on 2D EOS™ and X-ray images. RESULTS A t-test comparing 2D EOS™ with X-ray images showed no significant difference in all angle and length measurements (P > 0.05). When analysing observers separately, all measurements showed no significant difference, apart from the femoral anatomic-mechanical angle (fAMA) from observer 2 (2D EOS™ fAMA 6.21° vs. X-ray fAMA 7.10°, P = 0.02). Intra-observer intraclass correlation coefficient (ICC) for 2D EOS™ and X-ray was 1.00 and 1.00, respectively, and inter-observer ICC was 1.00 and 0.99, respectively. A t-test comparing 2D- with 3D EOS™ images showed no significant difference in all measurements. A t-test comparing 3D EOS™ with X-ray images showed no significant difference in all measurements. CONCLUSION This study showed the EOS™ imaging system to be a valid alternative method of imaging lower limbs for alignment, measurements and preoperative arthroplasty planning.
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Affiliation(s)
| | | | - Ronald Jing Ning Chan
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Kwong Yin Chung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Wai Wang Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Ki Wai Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Huang J, Tian F, Zhang Z, Shi W, Lin J, Chen L, Yang H. Reliability and concurrent validity of angle measurements in lower limb: EOS 3D goniometer versus 2D manual goniometer. J Orthop Translat 2020; 24:96-102. [PMID: 32775201 PMCID: PMC7390786 DOI: 10.1016/j.jot.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 10/27/2022] Open
Abstract
Background In clinical routine, preoperative radiographic assessment of lower extremity geometry relies on conventional X-rays. However, the plane goniometric measuring has several limitations in accurately locating anatomical landmarks. The purpose of this study is to propose a fast and accurate 3D-reconstruction-method based on biplanar X-rays with clinical measurements assessment in standing position. Methods 50 candidates for HTO or DFO with deformity of the lower extremities were included in this study. Biplanar X-rays were performed using the EOS imaging system in conventional double-stance full weight-bearing position (DS) and shifted-foot standing position (SF). The results of hip-knee-ankle angle (HKAA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were evaluated by either 2D manual goniometer (MG) based on X-ray in DS standing position or 3D-reconstruction goniometer based on X-rays in SF standing position. Results For the reproducibility study, MG and EOS goniometer were both reliable in repeated measures of HKAA, LDFA, and MPTA, with average concordance correlation coefficients (CCCs) all above 0.910. The agreements between MG and EOS measurements were high for HKAA and LDFA with CCCs all above 0.90, while the agreement was low for MPTA with CCC below 0.75. Further linear regression model analysis also revealed a significant correlation between MG and EOS measurements for HKAA (all R2 ≥ 0.93) and LDFA (all R2 ≥ 0.90), but not for MPTA (all R2 ≤ 0.522). Conclusion In comparison with the traditional 2D manual goniometer, EOS 3D reconstruction based goniometric measuring could provide equivalent results of HKAA and LDFA, and potentially a more accurate result of MPTA. These findings suggest that EOS 3D reconstruction based goniometric measuring is suitable for preoperative evaluation and planning for HTO/DFO. However, future improvements of the 3D reconstruction method are needed for better detection of the femoral condyles and tibial plates without the requirement of shifted-foot standing position. The translational potential of this article EOS 3D reconstruction based goniometric measuring could provide equivalent or even more accurate results of HKAA, LDFA, and MPTA, in comparison with the traditional 2D manual goniometer, making it suitable for preoperative evaluation and planning for HTO/DFO.
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Affiliation(s)
- Jun Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fanli Tian
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, China
| | - Zhigang Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weidong Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liang Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Emerging Techniques in Diagnostic Imaging for Idiopathic Scoliosis in Children and Adolescents: A Review of the Literature. World Neurosurg 2020; 136:128-135. [DOI: 10.1016/j.wneu.2020.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
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PRATALI RAPHAELDEREZENDE, DAHER MURILOTAVARES, MEVES ROBERT. BIPLANAR IMAGING WITH TRIDIMENSIONAL CAPABILITIES: APPLICABILITY OF THIS NEW EXAMINATION TO SPINAL DEFORMITIES. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201901222631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.
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Affiliation(s)
| | | | - ROBERT MEVES
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Brazil
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31
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Shih YC, Chau MM, Arendt EA, Novacheck TF. Measuring Lower Extremity Rotational Alignment: A Review of Methods and Case Studies of Clinical Applications. J Bone Joint Surg Am 2020; 102:343-356. [PMID: 31743239 DOI: 10.2106/jbjs.18.01115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yushane C Shih
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael M Chau
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth A Arendt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tom F Novacheck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.,Gillette Children's Specialty Healthcare, St. Paul, Minnesota
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Pietton R, Bouloussa H, Vergari C, Skalli W, Vialle R. Rib Cage Measurement Reproducibility Using Biplanar Stereoradiographic 3D Reconstructions in Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2020; 40:36-41. [PMID: 31815860 DOI: 10.1097/bpo.0000000000001095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A reproducibility study of preoperative rib cage three-dimensional (3D) measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). No prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Our objective was to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery. METHODS This series includes 21 patients with Lenke 1 or 2 scoliosis (74±20 degrees). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility, and intraclass coefficients (ICC) were calculated and compared between groups. RESULTS The average rib cage volume was 4.71 L (SD±0.75 L). Two SD was 0.19 L with a coefficient of variation of 4.1%; ICC was 0.968. The thoracic index was 0.6 (SD±0.1). Two SD was 0.03 with a coefficient of variation of 4.7% and a ICC of 0.820. As for the Spinal Penetration Index (6.4%; SD±2.4), 2SD was 0.9% with a coefficient of variation of 14.3% and a ICC of 0.901. The 3D rib hump 2SD (average 27±8 degrees) was 1.4 degrees. The coefficient of variation and ICC were respectively 5.1% and 0.991. CONCLUSIONS Three-dimensional reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS. LEVEL OF EVIDENCE Level IV-diagnostic study.
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Affiliation(s)
- Raphael Pietton
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Houssam Bouloussa
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
| | - Claudio Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
- School of Physics and Astronomy, University of Exeter, Exeter, UK
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Raphael Vialle
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
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Abstract
BACKGROUND Torsion is a frequent reason for consultation in paediatric orthopaedics. Torsion of the femur and the tibia in children change during growth. Depending on the age and possibility for compensation, this can be reflected in the gait pattern. Different causes can affect the normal development of torsion. DIAGNOSTICS In the context of paediatric orthopaedic assessment, the distinction between physiological and pathological torsion is essential. In addition to the patient history and observation of the gait pattern, as well as a detailed clinical examination, additional imaging techniques are used (Rippstein/Dunn, torsional CT/MRI, EOS). The dynamic effect of abnormal torsion on gait is evaluated by instrumented 3D gait analysis. PATHOGENESIS Evidence for the long-term significance of torsional deviations and the risk of consequential damage are low. Isolated increased femoral anteversion without accompanying hip dysplasia is fundamentally harmless, corrects during growth and only rarely needs correction in the case of ongoing disturbing gait or knee problems. In contrast, retroversion is likely indicate the development of pre-arthritic deformity and should be observed and treated more carefully. Tibial torsion shows great variability and may influence the development of femoral torsion. Torsional deformities in children with neurological or syndromal conditions are differentiated as when the biomechanical effects of torsions on their gait function are generally more marked and therefore treatment is more frequently necessary. THERAPY Conservative treatments cannot be expected to have an effect on the condition of the bones. Correction can only be achieved surgically with a rotational osteotomy. A simple principle underlies the technique, whereas indication and timing are challenging.
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Shim J, Yoon M, Lee Y. Feasibility of fast non local means filter in pediatric chest x-ray for increasing of pulmonary nodule detectability with 3D printed lung nodule phantom. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:872-890. [PMID: 31167171 DOI: 10.1088/1361-6498/ab2755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
General x-ray images have a lower probability of nodule detection than other modalities. Especially in children, the probability of nodule detection can likely drop due to poor image quality from using low radiation dose. To demonstrate the effectiveness of fast non-local means (FNLM) filter to increase the probability of nodule detection in pediatric chest x-ray images and reduce radiation dose while maintaining image quality. Quantitative assessment of normalised noise power spectrum (NNPS), coefficient of variation (COV) and contrast to noise ratio (CNR) were performed after applying four filters (median, Wiener, total variation and FNLM) on a 1-year-old child phantom. A 3D-printed patient nodule phantom was inserted into the phantom. Assessment was performed on AP and LAT view images acquired with the tube voltage reduced to 38 and 27%, and tube current reduced to 84 and 61%, respectively. The results showed the lowest NNPS and COV values and the highest CNR value when the FNLM filter applied. Moreover, the AP view results showed 37% decrease in COV and 30% increase in CNR in images with the FNLM filter applied (images exposed with the tube voltage and current reduced to 29% and 50%, respectively). The LAT view results showed 5% decrease in COV and 36% increase in CNR in images with the FNLM filter applied (images exposed with the tube current reduced by 27%). By applying the FNLM filter, the probability of nodule detection could be increased by denoising and contrast enhancement. Moreover, using the FNLM filter could reduce cancer risk in pediatric patients by reducing radiation dose about 30% to 44%.
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Affiliation(s)
- Jina Shim
- Department of Bio-Convergence Engineering, Korea University, Seoul, Republic of Korea. Department of Diagnostic Radiology, Severance Hospital, Seoul, Republic of Korea
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A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study. Clin Spine Surg 2019; 32:E340-E345. [PMID: 31162186 DOI: 10.1097/bsd.0000000000000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN This was a prospective validation study with technical notes. OBJECTIVE This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the "nano-dose" protocol. SUMMARY OF BACKGROUND DATA Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced. METHODS An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction. RESULTS A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals. CONCLUSIONS We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
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Mussmann B, Jensen C, Bensen AS, Torfing T, Ovesen O, Overgaard S. Radiographic signs of acetabular retroversion using a low-dose slot-scanning radiographic system (EOS ®). Radiography (Lond) 2019; 25:e53-e57. [PMID: 31301791 DOI: 10.1016/j.radi.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/28/2018] [Accepted: 01/03/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Acetabular retroversion is assessed using pelvic X-ray. Cross-over-sign (COS), posterior-wall-sign (PWS) and ischial-spine-sign (ISS) are important radiographic signs of the condition. The pelvic area is sensitive to radiation and thus, possibilities to reduce dose should be considered. The purpose was to compare radiographic signs of acetabular retroversion on conventional pelvic anteroposterior (AP) X-rays with a low-dose slot-scanning system (EOS) in a sample of patients with retroversion of the acetabulum and to compare the radiation doses. METHODS 34 participants with radiographic signs of acetabular retroversion in one or both hips on conventional pelvic X-ray were consecutively recruited. Pelvic EOS-images were acquired in each patient and COS, PWS, ISS, COS-ratio and PWS-ratio was assessed. Radiation dose comparison of X-ray vs. EOS was performed using Dose-Area Products. RESULTS Retroversion was present in 57 out of 68 hips. The absolute agreement was 91%, 84% and 76% for COS, PWS and ISS, respectively. No statistically significant differences were present between COS-ratio and PWS-ratio in either modality and Bland-Altman limits of agreement were narrow. The mean radiation dose was 1053 mGy*cm2 in X-ray and 593 mGy*cm2 in EOS (p = 0.003). CONCLUSION The results indicate that pelvic EOS provides diagnostic qualities similar to conventional X-ray using 44% less radiation when radiographic signs of acetabular retroversion are assessed.
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Affiliation(s)
- B Mussmann
- Department of Radiology, Odense University Hospital, DK-5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, DK-5000, Odense C, Denmark.
| | - C Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, DK-5000, Odense C, Denmark.
| | - A S Bensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, DK-5000, Odense C, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, DK-9000, Aalborg, Denmark.
| | - T Torfing
- Department of Radiology, Odense University Hospital, DK-5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, DK-5000, Odense C, Denmark.
| | - O Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, DK-5000, Odense C, Denmark.
| | - S Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, DK-5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, DK-5000, Odense C, Denmark.
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Oakley PA, Ehsani NN, Harrison DE. The Scoliosis Quandary: Are Radiation Exposures From Repeated X-Rays Harmful? Dose Response 2019; 17:1559325819852810. [PMID: 31217755 PMCID: PMC6560808 DOI: 10.1177/1559325819852810] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
X-rays have been the gold standard for diagnosis, evaluation, and management of spinal scoliosis for decades as other assessment methods are indirect, too expensive, or not practical in practice. The average scoliosis patient will receive 10 to 25 spinal X-rays over several years equating to a maximum estimated dose of 10 to 25 mGy. Some patients, those getting diagnosed at a younger age and receiving early and ongoing treatments, may receive up to 40 to 50 X-rays, approaching at most 50 mGy. There are concerns that repeated radiographs given to patients are carcinogenic. Some studies have used the linear no-threshold model to derive cancer-risk estimates; however, it is invalid for low-dose irradiation (ie, X-rays); these estimates are untrue. Other studies have calculated cancer-risk ratios from long-term health data of historic scoliosis cohorts. Since data indicate reduced cancer rates in a cohort receiving a total radiation dose between 50 and 300 mGy, it is unlikely that scoliosis patients would get cancer from repeated X-rays. Moreover, since the threshold for leukemia is about 1100 mGy, scoliosis patients will not likely develop cancers from spinal X-rays. Scoliosis patients likely have long-term health consequences, including cancers, from the actual disease entity itself and not from protracted X-ray radiation exposures that are essential and indeed safe.
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Illés TS, Lavaste F, Dubousset JF. The third dimension of scoliosis: The forgotten axial plane. Orthop Traumatol Surg Res 2019; 105:351-359. [PMID: 30665877 DOI: 10.1016/j.otsr.2018.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 02/02/2023]
Abstract
Idiopathic scoliosis is a three-dimensional (3D) deformity of the spine. In clinical practice, however, the diagnosis and treatment of scoliosis consider only two dimensions (2D) as they rely solely on postero-anterior (PA) and lateral radiographs. Thus, the projections of the deformity are evaluated in only the coronal and sagittal planes, whereas those in the axial plane are disregarded, precluding an accurate assessment of the 3D deformity. A universal dogma in engineering is that designing a 3D object requires drawing projections of the object in all three planes. Similarly, when dealing with a 3D deformity, knowledge of the abnormalities in all three planes is crucial, as each plane is as important as the other two planes. This article reviews the chronological development of axial plane imaging and spinal deformity measurement.
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Affiliation(s)
- Tamás S Illés
- Orthopaedic and Trauma Surgery, CHU-Brugmann, Université Libre de Bruxelles/Vrije Universiteit Brussel, Brussels, Belgium; Orthopaedic and Trauma Surgery, CHU-Odense and Clinical Research Institute, Denmark South University, Odense, Denmark; Académie Nationale de Médecine, 16, rue Bonaparte, 75006 Paris, France.
| | - Francois Lavaste
- Institute of Biomechanics Human Georges-Charpak, Arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean F Dubousset
- Académie Nationale de Médecine, 16, rue Bonaparte, 75006 Paris, France
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EOS Micro-dose Protocol: First Full-spine Radiation Dose Measurements in Anthropomorphic Phantoms and Comparisons with EOS Standard-dose and Conventional Digital Radiology. Spine (Phila Pa 1976) 2018; 43:E1313-E1321. [PMID: 30383725 DOI: 10.1097/brs.0000000000002696] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A comparative study of radiation dose measured in anthropomorphic phantoms. OBJECTIVES The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR). SUMMARY OF BACKGROUND DATA Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol. METHODS Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters. RESULTS We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed.For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system. CONCLUSION The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom. LEVEL OF EVIDENCE N/A.
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Ng SY, Bettany-Saltikov J. Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis. Open Orthop J 2017; 11:1500-1520. [PMID: 29399226 PMCID: PMC5759132 DOI: 10.2174/1874325001711011500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Shu-Yan Ng
- Wanchai Chiropractic Clinic, 11/fl China Hong Kong Tower, 8 Hennessy Road, Wanchai, Hong Kong
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Chiron P, Demoulin L, Wytrykowski K, Cavaignac E, Reina N, Murgier J. Radiation dose and magnification in pelvic X-ray: EOS™ imaging system versus plain radiographs. Orthop Traumatol Surg Res 2017; 103:1155-1159. [PMID: 28942025 DOI: 10.1016/j.otsr.2017.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/29/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND In plain pelvic X-ray, magnification makes measurement unreliable. The EOS™ (EOS Imaging, Paris France) imaging system is reputed to reproduce patient anatomy exactly, with a lower radiation dose. This, however, has not been assessed according to patient weight, although both magnification and irradiation are known to vary with weight. We therefore conducted a prospective comparative study, to compare: (1) image magnification and (2) radiation dose between the EOS imaging system and plain X-ray. HYPOTHESIS The EOS imaging system reproduces patient anatomy exactly, regardless of weight, unlike plain X-ray. MATERIAL AND METHOD A single-center comparative study of plain pelvic X-ray and 2D EOS radiography was performed in 183 patients: 186 arthroplasties; 104 male, 81 female; mean age 61.3±13.7years (range, 24-87years). Magnification and radiation dose (dose-area product [DAP]) were compared between the two systems in 186 hips in patients with a mean body-mass index (BMI) of 27.1±5.3kg/m2 (range, 17.6-42.3kg/m2), including 7 with morbid obesity. RESULTS Mean magnification was zero using the EOS system, regardless of patient weight, compared to 1.15±0.05 (range, 1-1.32) on plain X-ray (P<10-5). In patients with BMI<25, mean magnification on plain X-ray was 1.15±0.05 (range, 1-1.25) and, in patients with morbid obesity, 1.22±0.06 (range, 1.18-1.32). The mean radiation dose was 8.19±2.63dGy/cm2 (range, 1.77-14.24) with the EOS system, versus 19.38±12.37dGy/cm2 (range, 4.77-81.75) with plain X-ray (P<10-4). For BMI >40, mean radiation dose was 9.36±2.57dGy/cm2 (range, 7.4-14.2) with the EOS system, versus 44.76±22.21 (range, 25.2-81.7) with plain X-ray. Radiation dose increased by 0.20dGy with each extra BMI point for the EOS system, versus 0.74dGy for plain X-ray. CONCLUSION Magnification did not vary with patient weight using the EOS system, unlike plain X-ray, and radiation dose was 2.5-fold lower. LEVEL OF EVIDENCE 3, prospective case-control study.
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Affiliation(s)
- P Chiron
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - L Demoulin
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - K Wytrykowski
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - E Cavaignac
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - N Reina
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - J Murgier
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Jensen J, Mussmann BR, Hjarbæk J, Al-Aubaidi Z, Pedersen NW, Gerke O, Torfing T. Microdose acquisition in adolescent leg length discrepancy using a low-dose biplane imaging system. Acta Radiol 2017; 58:1108-1114. [PMID: 28068825 DOI: 10.1177/0284185116682381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Children with leg length discrepancy often undergo repeat imaging. Therefore, every effort to reduce radiation dose is important. Using low dose preview images and noise reduction software rather than diagnostic images for length measurements might contribute to reducing dose. Purpose To compare leg length measurements performed on diagnostic images and low dose preview images both acquired using a low-dose bi-planar imaging system. Material and Methods Preview and diagnostic images from 22 patients were retrospectively collected (14 girls, 8 boys; mean age, 12.8 years; age range, 10-15 years). All images were anonymized and measured independently by two musculoskeletal radiologists. Three sets of measurements were performed on all images; the mechanical axis lines of the femur and the tibia as well as the anatomical line of the entire extremity. Statistical significance was tested with a paired t-test. Results No statistically significant difference was found between measurements performed on the preview and on the diagnostic image. The mean tibial length difference between the observers was -0.06 cm (95% confidence interval [CI], -0.12 to 0.01) and -0.08 cm (95% CI, -0.21 to 0.05), respectively; 0.10 cm (95% CI, 0.02-0.17) and 0.06 cm (95% CI, -0.02 to 0.14) for the femoral measurements and 0.12 cm (95% CI, -0.05 to 0.26) and 0.08 cm (95% CI, -0.02 to 0.19) for total leg length discrepancy. ICCs were >0.99 indicating excellent inter- and intra-rater reliability. Conclusion The data strongly imply that leg length measurements performed on preview images from a low-dose bi-planar imaging system are comparable to measurements performed on diagnostic images.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Bo R Mussmann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - John Hjarbæk
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Zaid Al-Aubaidi
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Niels W Pedersen
- Department of Orthopedics, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense, Denmark
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Ferrero E, Lafage R, Diebo BG, Challier V, Ilharreborde B, Schwab F, Skalli W, Guigui P, Lafage V. Tridimensional Analysis of Rotatory Subluxation and Sagittal Spinopelvic Alignment in the Setting of Adult Spinal Deformity. Spine Deform 2017. [PMID: 28622901 DOI: 10.1016/j.jspd.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective single-center. OBJECTIVE To investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes. BACKGROUND Recent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes. However, there is still a lack of knowledge regarding the clinical impact of 3D evaluation and rotatory subluxation. Recent developments in stereoradiography allow clinicians to obtain full-body standing radiographs with low-dose radiation and 3D reconstruction. METHODS One hundred thirty lumbar ASD patients underwent full-spine biplanar radiographs (EOS Imaging, Paris, France). Clinical outcomes were recorded. Using sterEOS software, spinopelvic parameters and lateral listhesis were measured. 3D transverse plane parameters included apical axial vertebral rotation, axial intervertebral rotation (AIR), and torsion index (sum of AIR in the curve). ASD patients were divided in three groups: AIR <5°, 5°< AIR <10°, AIR >10°. Groups were compared with respect to radiographic and clinical data. Correlations were performed between the transverse and sagittal plane parameters and clinical outcomes. RESULTS Patients with AIR >10° were significantly older, with larger Cobb angle (39.5°) and greater sagittal plane deformity (pelvic incidence-lumbar lordosis mismatch 11.7° and pelvic tilt 22.6°). The AIR >10° group had significantly greater apical vertebra axial rotation apex (24.8°), torsion index (45°), and upper-level AIR (21.5°) than the two other groups. Overall, 27% of AIR patients did not have two-dimensional (2D) lateral listhesis. Patients with AIR >10° had significantly worse Oswestry Disability Index and more low back pain. CONCLUSION For patients in which lateral listhesis was unreadable in 2D imaging, rotatory subluxation was revealed using stereoradiography and at an earlier disease stage. Moreover, different 3D transverse plane parameters are related to different patient-reported outcomes. Therefore, axial rotation can be considered in evaluation of lumbar degenerative scoliosis severity and prognosis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emmanuelle Ferrero
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA; Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France.
| | - Renaud Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Bassel G Diebo
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Vincent Challier
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Brice Ilharreborde
- Orthopaedic Surgery, Robert Debré Hospital, 48 Bd Sérurier, 75019 Paris, France
| | - Frank Schwab
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Wafa Skalli
- Laboratoire de Biomécanique, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery, Hopital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France
| | - Virginie Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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Meijer MF, Boerboom AL, Bulstra SK, Reininga IHF, Stevens M. Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA? Knee Surg Sports Traumatol Arthrosc 2017; 25:2894-2903. [PMID: 26913857 PMCID: PMC5570772 DOI: 10.1007/s00167-016-4031-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Objective of this study was to compare intraoperative computer-assisted surgery (CAS) alignment measurements during total knee arthroplasty (TKA) with pre- and postoperative coronal alignment measurements using EOS 3D reconstructions. METHODS In a prospective study, 56 TKAs using imageless CAS were performed and coronal alignment measurements were recorded twice: before bone cuts were made and after implantation of the prosthesis. Pre- and postoperative coronal alignment measurements were performed using EOS 3D reconstructions. Thanks to the EOS radiostereography system, measurement errors due to malpositioning and deformity during acquisition are eliminated. CAS measurements were compared with EOS 3D reconstructions. Varus/valgus angle (VV), mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured. RESULTS Significantly different VV angles were measured pre- and postoperatively with CAS compared to EOS. For preoperative measurements, mLDFA did not differ significantly, but a significantly larger mMPTA in valgus was measured with CAS. CONCLUSION Results of this study indicate that differences in alignment measurements between CAS measurements and pre- and postoperative EOS 3D are due mainly to the difference between weight-bearing and non-weight-bearing position and potential errors in validity and reliability of the CAS system. EOS 3D measurements overestimate VV angle in lower limbs with substantial mechanical axis deviation. For lower limbs with minor mechanical axis deviation as well as for mMPTA measurements, CAS measures more valgus than EOS. Eventually the results of this study are of clinical relevance, since it raises concerns regarding the validity and reliability of CAS systems in TKA. LEVEL OF EVIDENCE IIb.
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Affiliation(s)
- Marrigje F. Meijer
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Alexander L. Boerboom
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Hui SCN, Pialasse JP, Wong JYH, Lam TP, Ng BKW, Cheng JCY, Chu WCW. Radiation dose of digital radiography (DR) versus micro-dose x-ray (EOS) on patients with adolescent idiopathic scoliosis: 2016 SOSORT- IRSSD "John Sevastic Award" Winner in Imaging Research. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:46. [PMID: 28035336 PMCID: PMC5198497 DOI: 10.1186/s13013-016-0106-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with adolescent idiopathic scoliosis (AIS) frequently receive x-ray imaging at diagnosis and subsequent follow monitoring. The ionizing radiation exposure has accumulated through their development stage and the effect of radiation to this young vulnerable group of patients is uncertain. To achieve the ALARA (as low as reasonably achievable) concept of radiation dose in medical imaging, a slot-scanning x-ray technique by the EOS system has been adopted and the radiation dose using micro-dose protocol was compared with the standard digital radiography on patients with AIS. METHODS Ninety-nine participants with AIS underwent micro-dose EOS and 33 underwent standard digital radiography (DR) for imaging of the whole spine. Entrance-skin dose was measured using thermoluminescent dosimeters (TLD) at three regions (i.e. dorsal sites at the level of sternal notch, nipple line, symphysis pubis). Effective dose and organ dose were calculated by simulation using PCXMC 2.0. Data from two x-ray systems were compared using independent-samples t-test and significance level at 0.05. All TLD measurements were conducted on PA projection only. Image quality was also assessed by two raters using Cobb angle measurement and a set of imaging parameters for optimization purposes. RESULTS Entrance-skin dose from micro-dose EOS system was 5.9-27.0 times lower at various regions compared with standard DR. The calculated effective dose was 2.6 ± 0.5 (μSv) and 67.5 ± 23.3 (μSv) from micro-dose and standard DR, respectively. The reduction in the micro-dose was approximately 26 times. Organ doses at thyroid, lung and gonad regions were significantly lower in micro-dose (p < 0.001). Data were further compared within the different gender groups. Females received significantly higher (p < 0.001) organ dose at ovaries compared to the testes in males. Patients with AIS received approximately 16-34 times lesser organ dose from micro-dose x-ray as compared with the standard DR. There was no significant difference in overall rating of imaging quality between EOS and DR. Micro-dose protocol provided enough quality to perform consistent measurement on Cobb angle. CONCLUSIONS Entrance-skin dose, effective dose and organ dose were significantly reduced in micro-dose x-ray. The effective dose of a single micro-dose x-ray (2.6 μSv) was less than a day of background radiation. As AIS patients require periodic x-ray follow up for surveillance of curve progression, clinical use of micro-dose x-ray system is beneficial for these young patients to reduce the intake of ionizing radiation.
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Affiliation(s)
- Steve C N Hui
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Jean-Philippe Pialasse
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China ; Department of Chiropractic, University of Quebec at Trois-Rivieres, Trois-Rivieres, Quebec Canada
| | - Judy Y H Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Tsz-Ping Lam
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Bobby K W Ng
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Jack C Y Cheng
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
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Ferrero E, Lafage R, Vira S, Rohan PY, Oren J, Delsole E, Guigui P, Schwab F, Lafage V, Skalli W. Three-dimensional reconstruction using stereoradiography for evaluating adult spinal deformity: a reproducibility study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:2112-2120. [PMID: 27817139 DOI: 10.1007/s00586-016-4833-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/25/2016] [Accepted: 10/19/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE In addition to the sagittal alignment, impact of transverse plane parameters (TPP) and rotatory subluxation on patients reported outcomes were highlighted. One of the hypotheses for genesis of degenerative scoliosis is disc degeneration with increased axial vertebral (AVR) and intervertebral rotation (AIR). Therefore, TPP analysis at early stage of the scoliosis seems of particular interest. This study aims at assessing reliability of tridimensional (3D) reconstructions of adult spinal deformity (ASD) patients. METHODS Thirty ASD patients underwent biplanar radiographs and were divided into two groups (Cobb angle >30° or <30°). Spinal parameters and TPP (apical AVR, AIR of upper and lower level of main curve) were measured. Four operators performed 3D reconstructions twice. Intra and inter-observer reliabilities were analyzed using ISO standard 5725-2, to quantify the global standard deviation of reproducibility (S R). RESULTS Mean Cobb angle was 31°, mean age 55 years (70% of female). Mean values of apical AVR, upper and lower level AIR were, respectively, 16° ± 15°, 6° ± 6° and 5° ± 5°. Spinopelvic parameters S R were below 4.5°. For Cobb angle <30°, S R was 7.8°, 9.6°, 4.5° and 4.9°, respectively, for AVR apex, torsion index, upper and lower AIR. Reliability was worse in the group of patients with Cobb angle above 30°. CONCLUSIONS 3D analysis was reliable for Cobb and sagittal parameters. 3D analysis for TPP was reproducible when Cobb is below 30°. However, uncertainty is larger for Cobb above 30°. Nevertheless, 3D reconstructions could help surgeons to anticipate onset of rotatory subluxation while assessing axial rotation evolution for small deformity and choose best delay for surgical treatment.
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Affiliation(s)
- Emmanuelle Ferrero
- Department of Orthopaedic Surgery, Hopital Européen Georges Pompidou, APHP, Paris V University, 20 rue Leblanc, 75015, Paris, France. .,Laboratoire de biomécanique Georges Charpak, Ecole nationale supérieure des arts et métiers, 75013, Paris, France.
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Pierre-Yves Rohan
- Laboratoire de biomécanique Georges Charpak, Ecole nationale supérieure des arts et métiers, 75013, Paris, France
| | - Jonathan Oren
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Edward Delsole
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Pierre Guigui
- Department of Orthopaedic Surgery, Hopital Européen Georges Pompidou, APHP, Paris V University, 20 rue Leblanc, 75015, Paris, France
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Wafa Skalli
- Laboratoire de biomécanique Georges Charpak, Ecole nationale supérieure des arts et métiers, 75013, Paris, France
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Morvan A, Moreau S, Combourieu B, Pansard E, Marmorat JL, Carlier R, Judet T, Lonjon G. Standing radiological analysis with a low-dose biplanar imaging system (EOS system) of the position of the components in total hip arthroplasty using an anterior approach. Bone Joint J 2016; 98-B:326-33. [DOI: 10.1302/0301-620x.98b3.36289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The primary aim of this study was to analyse the position of the acetabular and femoral components in total hip arthroplasty undertaken using an anterior surgical approach. Patients and Methods In a prospective, single centre study, we used the EOS imaging system to analyse the position of components following THA performed via the anterior approach in 102 patients (103 hips) with a mean age of 64.7 years (sd 12.6). Images were taken with patients in the standing position, allowing measurement of both anatomical and functional anteversion of the acetabular component. Results The mean inclination of the acetabular component was 39° (standard deviation (sd) 6), the mean anatomical anteversion was 30° (sd 10), and the mean functional anteversion was 31° (sd 8) five days after surgery. The mean anteversion of the femoral component was 20° (sd 11). Anatomical and functional anteversion of the acetabular component differed by > 10° in 23 (22%) cases. Pelvic tilt was the only pre-operative predictive factor of this difference. Conclusion Our study showed that anteversion of the acetabular component following THA using the anterior approach was greater than the recommended target value, and that substantial differences were observed in some patients when measured using two different measurement planes. If these results are confirmed by further studies, and considering that the anterior approach is intended to limit the incidence of dislocation, a new correlation study for each reference plane (anatomical and functional) will be necessary to define a ‘safe zone’ for use with the anterior approach. Take home message: EOS imaging system is helpful in the pre-operative and post-operative radiological analysis of total hip arthroplasty. Cite this article: Bone Joint J 2016;98-B:326–333.
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Affiliation(s)
- A. Morvan
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - S. Moreau
- Hôpital Européen George Pompidou, Service
orthopédie, 20 rue Leblanc, 75015
Paris, France
| | - B. Combourieu
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - E. Pansard
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - J. L. Marmorat
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - R. Carlier
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - T. Judet
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - G. Lonjon
- Hôpital Européen George Pompidou, Service
orthopédie, 20 rue Leblanc, 75015
Paris, France
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Dosanjh M, Cirilli M, Myers S, Navin S. Medical Applications at CERN and the ENLIGHT Network. Front Oncol 2016; 6:9. [PMID: 26835422 PMCID: PMC4724719 DOI: 10.3389/fonc.2016.00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/11/2016] [Indexed: 12/05/2022] Open
Abstract
State-of-the-art techniques derived from particle accelerators, detectors, and physics computing are routinely used in clinical practice and medical research centers: from imaging technologies to dedicated accelerators for cancer therapy and nuclear medicine, simulations, and data analytics. Principles of particle physics themselves are the foundation of a cutting edge radiotherapy technique for cancer treatment: hadron therapy. This article is an overview of the involvement of CERN, the European Organization for Nuclear Research, in medical applications, with specific focus on hadron therapy. It also presents the history, achievements, and future scientific goals of the European Network for Light Ion Hadron Therapy, whose co-ordination office is at CERN.
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Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 2016; 10:1-14. [PMID: 26883033 PMCID: PMC4763151 DOI: 10.1007/s11832-016-0713-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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Meijer MF, Velleman T, Boerboom AL, Bulstra SK, Otten E, Stevens M, Reininga IHF. The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements. PLoS One 2016; 11:e0146187. [PMID: 26771177 PMCID: PMC4714906 DOI: 10.1371/journal.pone.0146187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. Methods EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15° varus to 15° valgus and flexion angle from 0° to 20°, and changing rotation from 20° internal to 20° external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated. Results Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4° for VV2D; maximum variation for VV3D was only 1.5°. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8°, while the difference with VV3D was only 1.9°. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15° valgus, 20° flexion and 20° internal rotation. Conclusions After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition.
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Affiliation(s)
- Marrigje F. Meijer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ton Velleman
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L. Boerboom
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Egbert Otten
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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