Quantitative imaging of the spine in adolescent idiopathic scoliosis: shifting the paradigm from diagnostic to comprehensive prognostic evaluation

EOSedge vs. standard digital radiography: image quality and dose exposure in hip-focused scanning

OBJECTIVES

To compare the image quality and X-ray exposure dose from EOSedge versus standard digital radiography (SDR) focused on the hip for replacement or prosthesis revision surgery.

MATERIALS & METHODS

This prospective single centre study included 97 patients between November 2022 and April 2023. For preoperative assessment, SDR radiographs from frontal pelvic and hip profile were indispensable. Often, surgeon requested spine radiograph from EOSedge, to which we added frontal pelvic and hip profile. A radiologist with 4 years' experience established a score based on European guidelines to evaluate the EOSedge versus SDR image quality. Quality scores (QS) were compared using paired Student's t test. The entrance skin dose (ESD) and dose area product (DAP) of the images were recorded.

RESULTS

A total of 97 patients, including 49 women and 48 men (mean 68.10 years ± 13.28) were assessed. The QSEOSedge was significantly higher than the QSSDR, with differences of 1.34 ± 1.90 (p < 0.001) and 1.74 ± 1.90 (p < 0.001), respectively. The difference in total QS was 3.08 ± 3.48 (p < 0.001). The radiation delivered (ESD x DAP) by EOSedge was 29 times lower than that delivered by SDR for frontal pelvic imaging (0.35 ± 0.91 versus 10.20 ± 12.63; p < 0.001) and 17 times lower for hip profile imaging (0.41 ± 0.84 versus 6.91 ± 9.70; p < 0.001).

CONCLUSION

This study highlighted the superior image quality of EOSedge images focused on the pelvis and hip compared to SDR, with significantly less radiation exposure.

Health technology assessment in musculoskeletal radiology: the case study of EOSedge™

OBJECTIVES

Health technology assessment (HTA) is a systematic process used to evaluate the properties and effects of healthcare technologies within their intended use context. This paper describes the adoption of HTA process to assess the adoption of the EOSedge™ system in clinical practice.

METHODS

The EOSedge™ system is a digital radiography system that delivers whole-body, high-quality 2D/3D biplanar images covering the complete set of musculoskeletal and orthopedic exams. Full HTA model was chosen using the EUnetHTA Core Model® version 3.0. The HTA Core Model organizes the information into nine domains. Information was researched and obtained by consulting the manufacturers' user manuals, scientific literature, and institutional sites for regulatory aspects.

RESULTS

All nine domains of the EUnetHTA Core Model® helped conduct the HTA of the EOSedge, including (1) description and technical characteristics of the technology; (2) health problem and current clinical practice; (3) safety; (4) clinical effectiveness; (5) organizational aspects; (6) economic evaluation; (7) impact on the patient; (8) ethical aspects; and (9) legal aspects.

CONCLUSIONS

EOS technologies may be a viable alternative to conventional radiographs. EOSedge has the same intended use and similar indications for use, technological characteristics, and operation principles as the EOS System and provides significant dose reduction factors for whole spine imaging compared to the EOS System without compromising image quality. Regarding the impact of EOS imaging on patient outcomes, most studies aim to establish technical ability without evaluating their ability to improve patient outcomes; thus, more studies on this aspect are warranted.

3D Back Contour Metrics in Predicting Idiopathic Scoliosis Progression: Retrospective Cohort Analysis, Case Series Report and Proof of Concept

Adolescent Idiopathic Scoliosis is a 3D spinal deformity commonly characterized by serial radiographs. Patients with AIS may have increased average radiation exposure compared to unaffected patients and thus may be implicated with a modest increase in cancer risk. To minimize lifetime radiation exposure, alternative imaging modalities such as surface topography are being explored. Surface topography (ST) uses a camera to map anatomic landmarks of the spine and contours of the back to create software-generated spine models. ST has previously shown good correlation to radiographic measures. In this study, we sought to use ST in the creation of a risk stratification model. A total of 38 patients met the inclusion criteria for curve progression prediction. Scoliotic curves were classified as progressing, stabilized, or improving, and a predictive model was created using the proportional odds logistic modeling. The results showed that surface topography was able to moderately appraise scoliosis curvatures when compared to radiographs. The predictive model, using demographic and surface topography measurements, was able to account for 86.9% of the variability in the future Cobb angle. Additionally, attempts at classification of curve progression, stabilization, or improvement were accurately predicted 27/38 times, 71%. These results provide a basis for the creation of a clinical tool in the tracking and prediction of scoliosis progression in order to reduce the number of X-rays required.

Update on Pediatric Spine Imaging

The spine is often difficult to evaluate clinically in children, increasing the importance of diagnostic imaging to detect a wide variety of spinal disorders ranging from congenital abnormalities to severe infections. Clinical history and physical examination can help determine whether imaging is needed and which imaging technique would be best. The most common cause for back pain, even in children, is muscular strain/spasm that does not require any imaging. However, red flags such as pain at age < 5 years, constant pain, night pain, radicular pain, pain lasting > 4 weeks, or an abnormal neurologic examination may require further investigation. Imaging can be of great value for diagnosis but must be interpreted along with the clinical history, physical examination, and laboratory findings to achieve an accurate diagnosis. We discuss imaging for the most common and/or important spine pathologies in children: congenital and developmental pathologies, trauma, infectious processes, inflammatory causes, and tumors.