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Tomaiuolo R, Banfi G, Messina C, Albano D, Gitto S, Sconfienza LM. Health technology assessment in musculoskeletal radiology: the case study of EOSedge™. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01832-9. [PMID: 38856961 DOI: 10.1007/s11547-024-01832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
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.
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Affiliation(s)
- Rossella Tomaiuolo
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Al-Dasuqi K, Taylor E, Ehrlich L, Cooperman D, Socci A, Tuason D, Hoerner M, Staib L, Silva CT. Performance and reliability assessment of a lower dose, task-based scoliosis radiography protocol in pediatric patients. Pediatr Radiol 2024; 54:146-153. [PMID: 38010426 DOI: 10.1007/s00247-023-05812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Follow-up scoliosis radiographs are performed to assess the degree of spinal curvature and skeletal maturity, which can be done at lower radiation exposures than those in standard-dose radiography. OBJECTIVE Describe and evaluate a protocol that reduced the radiation in follow-up frontal-view scoliosis radiographs. MATERIALS AND METHODS We implemented a postero-anterior lower dose modified-technique for scoliosis radiography with task-based definition of adequate image quality and use of technique charts based on target exposure index and patient's height and weight. We subsequently retrospectively evaluated 40 consecutive patients who underwent a follow-up radiograph using the modified-technique after an initial standard-technique radiograph. We evaluated comparisons of proportions for subjective assessment with chi-squared tests, and agreements of reader's scores with intraclass correlation coefficients and Bland-Altman plots. We determined incident air kerma, exposure index, deviation index/standard deviation, dose-area product (DAP), and effective dose for each radiograph. We set statistical significance at P<0.05. RESULTS Forty patients (65% female), aged 4-17 years. Median effective dose was reduced from 39 to 10 µSv (P<0.001), incident air kerma from 139 to 29 µSv (P<0.001), and DAP from 266 to 55 mGy*cm2 (P<0.001). All modified-technique parameters were rated with a mean score of acceptable or above. All modified-technique measurements obtained inter- and intra-observer correlation coefficient agreements of 0.86 ("Good") or greater. CONCLUSION Substantial dose reduction on follow-up scoliosis imaging with existing radiography units is achievable through task-based definition of adequate image quality and tailoring of radiation to each patient's height and weight, while still allowing for reliable assessment and reproducible measurements.
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Affiliation(s)
- Khalid Al-Dasuqi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Erin Taylor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
- Advanced Diagnostic Imaging, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Lauren Ehrlich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Daniel Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Adrienne Socci
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Dominick Tuason
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Hoerner
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Lawrence Staib
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
- Department of Biomedical Engineering, Yale School of Engineering, New Haven, CT, USA
- Department of Electrical Engineering, Yale School of Engineering, New Haven, CT, USA
| | - Cicero T Silva
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
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Boissonnat G, Morichau-Beauchant P, Reshef A, Villa C, Désauté P, Simon AC. Performance of automatic exposure control on dose and image quality: comparison between slot-scanning and flat-panel digital radiography systems. Med Phys 2023; 50:1162-1184. [PMID: 36069636 DOI: 10.1002/mp.15954] [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: 09/28/2021] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND EOSedge™* (EOS Imaging, Paris, France) is an X-ray imaging system using automatic exposure control (AEC) with tube current modulation, in order to optimize dose deposition in patients. PURPOSE This study aims at characterizing EOSedge organ dose deposition in comparison to a digital radiography (DR) system and the previous EOS system (EOS-1st generation), in relation to their respective image quality levels. METHOD Organ doses were measured in an anthropomorphic female adult phantom and a 5-year-old pediatric phantom using optically stimulated luminescence (OSL) dosimeters, which were carefully calibrated within the studied energy range. Organ doses were recorded on the EOSedge and the Fuji Visionary DRF (Fujifilm Medical Systems U.S.A., Inc, Lexington, MA). The resulting effective doses were compared to the EOS-1st-generation values present in the literature. Image quality assessment was carried out on end-user images. Quantitative image quality metrics were computed for all tested modalities on a quality assurance phantom. Qualitative assessment of EOSedge image quality was based on anthropomorphic phantom acquisitions against the EOS-1st-generation system, and on clinical images against the tested DR system. RESULTS For a full-spine exam, and on the female adult phantom (respectively, the pediatric phantom), an effective dose of 92 μSv (respectively, 32 μSv) was obtained on EOSedge, and 572 μSv (respectively, 179 μSv) on the DR system; these values were compared to effective dose values of 290 μSv (respectively, 200 μSv) from the literature on EOS-1st generation, leading to an effective dose reduction factor of 6 with respect to the DR system, and of 3-6 with respect to EOS-1st generation. EOSedge provides the best compromise between contrast-to-noise ratio (CNR) and dose, with more consistent CNR values than the other tested modalities, in a range of attenuation from 10 to 40 cm of poly(methyl methacrylate) (PMMA). Within this range, EOSedge is also comparable to DR for 10 and 20 cm of PMMA, and better than DR for 30 and 40 cm of PMMA, both in terms of spatial resolution and low-contrast detection. The anatomical landmarks of interest in the follow-up of spinal deformities can be detected in all tested modalities. CONCLUSION Results showed that EOSedge provides significant dose reduction factors for full spine imaging in both adults and children compared to the other tested modalities, without compromising image quality. We believe that this work could help raise awareness on the capabilities of modern X-ray systems, when equipped with appropriate AEC strategies, to perform ultra-low-dose, long-axis images.
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Brage K, Mussmann B, Geijer M, Larsen P, Jensen J. Clinical application of EOS imaging system: a scoping review protocol. JBI Evid Synth 2023; 21:1009-1015. [PMID: 36633464 DOI: 10.11124/jbies-22-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this scoping review is to examine and map the existing literature on the clinical application of the EOS imaging system and to identify related evidence gaps. INTRODUCTION The EOS imaging system was originally developed to conduct imaging for medical conditions, such as scoliosis and anisomelia. However, recent research suggests that the modality has other clinical uses that may benefit patients via reduced radiation dose and, thus, improve patient safety. INCLUSION CRITERIA This scoping review will consider all quantitative study designs, including systematic reviews and meta-analyses. Imaging phantom studies and conference abstracts will be excluded. METHODS Databases that will be searched include Embase, MEDLINE, CINAHL Complete, Scopus, Cochrane Library, Academic Search Premier, and OpenGrey. Relevant secondary material will be identified using citation searching (backwards and forwards) of included studies through Google Scholar. In addition, we will search by author name where more than 3 included studies from the same first author are identified. Articles published from 2003 in English, Danish, Norwegian, Swedish, French, and German will be included. Two independent reviewers will perform title/abstract screening, followed by full-text screening. Data extraction will include study type and design, age of participants, anatomical/physiological region, pathology, clinical endpoint, outcome measures, sample size, and clinical application. Data will be presented in tabular format and as a narrative summary. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/yc85j/.
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Affiliation(s)
- Karen Brage
- Education of Radiography, UCL University College, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Bo Mussmann
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Palle Larsen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Usefulness of an Additional Filter Created Using 3D Printing for Whole-Body X-ray Imaging with a Long-Length Detector. SENSORS 2022; 22:s22114299. [PMID: 35684921 PMCID: PMC9185553 DOI: 10.3390/s22114299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023]
Abstract
We recently developed a long-length detector that combines three detectors and successfully acquires whole-body X-ray images. Although the developed detector system can efficiently acquire whole-body images in a short time, it may show problems with diagnostic performance in some areas owing to the use of high-energy X-rays during whole-spine and long-length examinations. In particular, during examinations of relatively thin bones, such as ankles, with a long-length detector, the image quality deteriorates because of an increase in X-ray transmission. An additional filter is primarily used to address this limitation, but this approach imposes a higher load on the X-ray tube to compensate for reductions in the radiation dose and the problem of high manufacturing costs. Thus, in this study, a newly designed additional filter was fabricated using 3D printing technology to improve the applicability of the long-length detector. Whole-spine anterior–posterior (AP), lateral, and long-leg AP X-ray examinations were performed using 3D-printed additional filters composed of 14 mm thick aluminum (Al) or 14 mm thick Al + 1 mm thick copper (Cu) composite material. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiation dose for the acquired X-ray images were evaluated to demonstrate the usefulness of the filters. Under all X-ray inspection conditions, the most effective data were obtained when the composite additional filter based on a 14 mm thick Al + 1 mm thick Cu material was used. We confirmed that an SNR improvement of up to 46%, CNR improvement of 37%, and radiation dose reduction of 90% could be achieved in the X-ray images obtained using the composite additional filter in comparison to the images obtained with no filter. The results proved that the additional filter made with a 3D printer was effective in improving image quality and reducing the radiation dose for X-ray images obtained using a long-length detector.
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Hamzian N, Roozmand Z, Abrisham SMJ, Abdollahi-Dehkordi S, Afereydoon S, Ghorbani M, Deevband MR. Monte Carlo evaluation of effective dose and risk of exposure induced cancer death (REID) for common examinations in stereo radiography (EOS) imaging: Considering age and gender. J Med Imaging Radiat Sci 2022; 53:283-290. [DOI: 10.1016/j.jmir.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/26/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
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Wong C, Adriansen J, Jeppsen J, Balslev-Clausen A. Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis. Acta Radiol Open 2021; 10:20584601211043258. [PMID: 34594575 PMCID: PMC8477696 DOI: 10.1177/20584601211043258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Radiographic images in adolescent idiopathic scoliosis (AIS) have a potential radiation-induced oncogenic effect; thus lowering radiation dose by using fluoroscopic imaging technique of low-dose fluoroscopic technique (LFT) which might be relevant for clinical evaluation. Purpose To compare radiographs of LFT with gold standard radiographs for AIS ordinary radiographic technique (ORT). Material and Methods Image quality was evaluated for LTF and ORT of a child phantom and two 3D-printed models (3DPSs) of AIS. We measured the primary physical characteristics of noise, contrast, spatial resolution, signal-to-noise ratio, and contrast-to-noise ratio. Three independent evaluators assessed the radiographs by observer-based methods of image criteria (ICS) and visual grading analysis(VGAS). Radiation doses were evaluated by the dose-area-product (DAP) of the 25 phantom radiographs. Reliability and agreement of Cobb’s angle (CA) and other radiographic parameters were evaluated on the 3DPSs and reliability on 342 LFT. Results The average noise and contrast were approximately 15-fold higher for LFT. SNR and CNR were similar. Overall, ICS and VGAS were 3-fold higher for ORT than for LFT for L3 and similar for Th6. Reliability and agreement were good for the experimental LFT, and the interclass correlation coefficient for CA was 0.852 for the clinical LFT. The average DAP and effective dose for LFT were 8-fold lower than those for ORT. Conclusion In conclusion, LFT is reliable for CA measurements and is thus useful for clinical outpatient follow-up evaluation. Even though the image quality is lower for LFT than ORT, the merits are the substantially reduced radiation and a lowered malignancy risk without compromising the measurement of Cobb’s angle, thus following the principles of ALARA.
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Affiliation(s)
- Christian Wong
- Department of Orthopedics, University Hospital of Hvidovre, Hvidovre, Denmark
| | - Jens Adriansen
- Department of Radiology, University Hospital of Hvidovre, Hvidovre, Denmark
| | - Jytte Jeppsen
- Center for Health Technology, University Hospital of Hvidovre, Hvidovre, Denmark
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Hirsch BP, Vaynrub M, Siow M, Zou A, Anil U, Montes DV, Protopsaltis TS. Visualization of the Cervicothoracic Junction With EOS Imaging Is Superior to Conventional Lateral Cervical Radiographs. Global Spine J 2021; 11:925-930. [PMID: 32677525 PMCID: PMC8258825 DOI: 10.1177/2192568220934486] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Single-center retrospective review. OBJECTIVES The cervicothoracic junction (CTJ) is typically difficult to visualize using traditional radiographs. Whole-body stereoradiography (EOS) allows for imaging of the entire axial skeleton in a weightbearing position without parallax error and with lower radiation doses. In this study we sought to compare the visibility of the vertebra of the CTJ on lateral EOS images to that of conventional cervical lateral radiographs. METHODS Two fellowship-trained spine surgeons evaluated the images of 50 patients who had both lateral cervical radiographs and EOS images acquired within a 12-month period. The number of visible cortices of the vertebral bodies of C6-T2 were scored 0-4. Patient body mass index and the presence of spondylolisthesis >2 mm at each level was recorded. The incidence of insufficient visibility to detect spondylolisthesis at each level was also calculated for both modalities. RESULTS On average, there were more visible cortices with EOS versus XR at T1 and T2, whereas visible cortices were equal at C6 and C7. Patient body mass index was inversely correlated with cortical visibility on XR at T2 and on EOS at T1 and T2. There was a significant difference in the incidence of insufficient visibility to detect spondylolisthesis on EOS versus XR at C7-T1 and T1-2, but not at C6-7. CONCLUSIONS EOS imaging is superior at imaging the vertebra of the CTJ. EOS imaging deserves further consideration as a diagnostic tool in the evaluation of patients with cervical deformity given its ability to produce high-quality images of the CTJ with less radiation exposure.
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Affiliation(s)
| | - Max Vaynrub
- New York University Langone Orthopaedic Hospital, New York, NY, USA
| | - Matthew Siow
- New York University Langone Orthopaedic Hospital, New York, NY, USA
| | - Anthony Zou
- New York University Langone Orthopaedic Hospital, New York, NY, USA
| | - Utkarsh Anil
- New York University Langone Orthopaedic Hospital, New York, NY, USA
| | | | - Themistocles S. Protopsaltis
- New York University Langone Orthopaedic Hospital, New York, NY, USA,Themistocles S. Protopsaltis, Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, 301 East 17th Street, New York, NY 10003, USA.
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Hamzian N, Afereydoon S, Ghorbani M, Abrisham SMJ, Roozmand Z, Abdollahi-Dehkordi S, Sepehr Javan M, Reza Deevband M. Equivalent Dose and Risk of Exposure Induced Cancer Death of Different Organs due to Various Image Techniques of EOS Imaging System. J Biomed Phys Eng 2021; 11:289-296. [PMID: 34189117 PMCID: PMC8236105 DOI: 10.31661/jbpe.v0i0.2012-1242] [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] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
Background: Euronext Paris Advanced Orthopedic Solutions (EOS) system is a new radiography system, capable of obtaining two-dimensional and three-dimensional images from bony structures in the body. Objective: The aim of this study is to estimate equivalent dose and the risk of exposure induced cancer death (REID) in different organs of body due to EOS imaging system. Material and Methods: In this experimental study, totally 120 patients were evaluated for various imaging techniques of lower limb, full spine and whole body. Equivalent dose and REID for colon, liver, lung, stomach, breast, bladder, ovary, blood cells (leukemia) and other organs were calculated using PCXMC software (version 2.0.1.2) based on Monte Carlo simulation of X-ray and human phantoms. The data on imaging technique, including age, sex, kVp, dose area product (DAP), mA, focal to detector distance were introduced as the input of PCXMC. Results: The maximum equivalent dose (mSv) due to EOS imaging system, was estimated for the bladder 0.240±0.066 for the full body technique and 0.240±0.093 for the lower limb technique, respectively, in both males and females. The maximum organ REID (incidence per million) due to EOS imaging system was estimated for lungs as 2.59±1.0 and 2.53±0.9, for the full body technique in both males and females, respectively. Conclusion: Generally, the equivalent dose and REID by EOS imaging system in different organs of body is low due to the low radiation dose received by the body in different techniques and views.
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Affiliation(s)
- Nima Hamzian
- PhD, Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeid Afereydoon
- MSc, Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdi Ghorbani
- PhD, Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Jalil Abrisham
- MD, Department of EOS Imaging, Shahid Sadoughi General Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Roozmand
- BSc, Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sepideh Abdollahi-Dehkordi
- MSc, Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Sepehr Javan
- BSc, Department of EOS Imaging, Shahid Sadoughi General Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Deevband
- PhD, Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhang X, Uneri A, Wu P, Ketcha MD, Jones CK, Huang Y, Lo SFL, Helm PA, Siewerdsen JH. Long-length tomosynthesis and 3D-2D registration for intraoperative assessment of spine instrumentation. Phys Med Biol 2021; 66:055008. [PMID: 33477120 DOI: 10.1088/1361-6560/abde96] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE A system for long-length intraoperative imaging is reported based on longitudinal motion of an O-arm gantry featuring a multi-slot collimator. We assess the utility of long-length tomosynthesis and the geometric accuracy of 3D image registration for surgical guidance and evaluation of long spinal constructs. METHODS A multi-slot collimator with tilted apertures was integrated into an O-arm system for long-length imaging. The multi-slot projective geometry leads to slight view disparity in both long-length projection images (referred to as 'line scans') and tomosynthesis 'slot reconstructions' produced using a weighted-backprojection method. The radiation dose for long-length imaging was measured, and the utility of long-length, intraoperative tomosynthesis was evaluated in phantom and cadaver studies. Leveraging the depth resolution provided by parallax views, an algorithm for 3D-2D registration of the patient and surgical devices was adapted for registration with line scans and slot reconstructions. Registration performance using single-plane or dual-plane long-length images was evaluated and compared to registration accuracy achieved using standard dual-plane radiographs. RESULTS Longitudinal coverage of ∼50-64 cm was achieved with a single long-length slot scan, providing a field-of-view (FOV) up to (40 × 64) cm2, depending on patient positioning. The dose-area product (reference point air kerma × x-ray field area) for a slot scan ranged from ∼702-1757 mGy·cm2, equivalent to ∼2.5 s of fluoroscopy and comparable to other long-length imaging systems. Long-length scanning produced high-resolution tomosynthesis reconstructions, covering ∼12-16 vertebral levels. 3D image registration using dual-plane slot reconstructions achieved median target registration error (TRE) of 1.2 mm and 0.6° in cadaver studies, outperforming registration to dual-plane line scans (TRE = 2.8 mm and 2.2°) and radiographs (TRE = 2.5 mm and 1.1°). 3D registration using single-plane slot reconstructions leveraged the ∼7-14° angular separation between slots to achieve median TRE ∼2 mm and <2° from a single scan. CONCLUSION The multi-slot configuration provided intraoperative visualization of long spine segments, facilitating target localization, assessment of global spinal alignment, and evaluation of long surgical constructs. 3D-2D registration to long-length tomosynthesis reconstructions yielded a promising means of guidance and verification with accuracy exceeding that of 3D-2D registration to conventional radiographs.
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Affiliation(s)
- Xiaoxuan Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, United States of America
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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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Choopani MR, Chaparian A. Introduction of a New Parameter for Evaluation of Digital Radiography System Performance. JOURNAL OF MEDICAL SIGNALS & SENSORS 2020; 10:196-200. [PMID: 33062611 PMCID: PMC7528983 DOI: 10.4103/jmss.jmss_53_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/16/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022]
Abstract
Background The aim of this study was to compare the image quality and radiation doses in various digital radiography systems using contrast-detail radiography (CDRAD) phantom. Methods The image quality and radiation dose for seven different digital radiography systems were compared using the CDRAD phantom. Incident air kerma (IAK) values were measured for certain exposure settings in all digital radiography systems. The images from the CDRAD phantom were evaluated by three observers. The results were displayed in the form of a contrast-detail (CD) curve. In addition, the inverse image quality figure (IQFinv)-to-IAK ratios were used for quantitative comparison of different digital radiography system performance. Results Results of this study showed that the CD curves cannot be suitable criterion for determining the performance of digital radiography systems. For this reason, IQFinv-to-radiation dose (IAK) ratios in a fixed radiation condition were used. The highest performance in terms of producing high-quality images and low radiation dose was related to X-ray unit 1 and the lowest performance was for X-ray unit 5. Conclusion The ratio of IQFinv to IAK for performance evaluation of digital radiography systems is an innovation of this study. A digital radiography system with a higher IQFinv-to-IAK ratio is associated with lower patient dose and better image quality. Therefore, it is recommended to equip the new imaging centers with the systems that have higher IQFinv-to-IAK ratios.
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Affiliation(s)
- Mohammad Reza Choopani
- Student Research Committee, Faculty of Paramedicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Chaparian
- Technology of Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Development and validation of a bespoke phantom to test accuracy of Cobb angle measurements. Radiography (Lond) 2020; 26:e78-e87. [PMID: 32052769 DOI: 10.1016/j.radi.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is a spinal deformity that causes the spine to bend laterally. Patients with AIS undergo frequent X-ray examinations to monitor the progression of the disorder by through the measurement of the Cobb angle. Frequent exposure of adolescents poses the risk of radiation-induced cancer. The aim of this research was to design and build a bespoke phantom representing a 10-year-old child with AIS to allow optimisation of imaging protocols for AIS assessment through the accuracy of Cobb angle measurements. METHODS Poly-methyl methacrylate (PMMA) and plaster of Paris (PoP) were used to represent human soft tissue and bone tissue, respectively, to construct a phantom exhibiting a 15° lateral curve of the spine. The phantom was validated by comparing the Hounsfield unit (HU) of its vertebrae with that of human and sheep. Additionally, comparisons of signal-to-noise ratio (SNR) to those from a commercially available phantom. An assessment of the accuracy of the radiographic assessment of the Cobb angle measurement was performed. RESULTS The HU of the PoP vertebrae was 628 (SD = 56), human vertebrae was 598 (SD = 79) and sheep vertebra was 605 (SD = 83). The SNR values of the two phantoms correlated strongly (r = 0.93 (p = 0.00)). The measured scoliosis angle was 14°. CONCLUSION The phantom has physical characteristics (in terms of spinal deformity) and radiological characteristics (in terms of HU and SNR values) of the spine of a 10-year-old child with AIS. This phantom has utility for the optimisation of x-ray imaging techniques in 10 year old children. IMPLICATIONS FOR PRACTICE A phantom to investigate new x-ray imaging techniques and technology in the assessment of scoliosis and to optimise currently used protocols.
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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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Duchaussoy T, Lacoste M, Norberciak L, Decaudain J, Verclytte S, Budzik JF. Preoperative assessment of idiopathic scoliosis in adolescent and young adult with three-dimensional T2-weighted spin-echo MRI. Diagn Interv Imaging 2019; 100:371-379. [PMID: 30878467 DOI: 10.1016/j.diii.2019.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare tridimensional (3D) T2-weighted spin-echo MRI and CT for minimal pedicle width measurements in the preoperative assessment of adolescent idiopathic scoliosis (AIS) in adolescent and young patients. MATERIALS AND METHODS A total of 22 adolescents/young patients suffering from AIS were retrospectively included. There were 18 females and 4 males with a mean age of 15.3±2.3 (SD) years (range: 11-21years). Preoperative lumbar spine MRI and CT examinations of the 22 patients were reviewed by two independent readers who measured the minimal width of 259 pedicles. Inter-reader agreement for CT and MRI was assessed using intra-class correlation coefficient (ICC). Intra-reader agreement and relative differences in measurements between MRI and CT were also assessed for each reader. RESULTS Inter-reader agreement was excellent (ICC≥0.8) for both CT and MRI. Relative differences in measurements between CT and MRI was 10.3% for reader 1 and 9.4% for reader 2. CONCLUSION 3D T2-weighted spin-echo MRI underestimates minimal pedicle width by only 9.4 - 10.3% compared to CT. 3D T2-weighted MRI appears as a valuable alternative to CT for preoperative measurements of vertebral pedicles in AIS.
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Affiliation(s)
- T Duchaussoy
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France
| | - M Lacoste
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France
| | - L Norberciak
- Lille Catholic Hospitals, Clinical Research and Innovation Department, 59000 Lille, France
| | - J Decaudain
- Lille Catholic Hospitals, Orthopedic Surgery Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France
| | - S Verclytte
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France
| | - J-F Budzik
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France; PMOI Physiopathology of Inflammatory Bone Diseases, EA 4490, 59000 Lille, 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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Yamato Y, Matsuyama Y. Will a low-dose biplanar radiograph become "gold standard" for three-dimensional assessment of spinal deformity in patients with adolescent idiopathic scoliosis? JOURNAL OF SPINE SURGERY 2018; 4:465-466. [PMID: 30069545 DOI: 10.21037/jss.2018.06.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
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Okamoto M, Jabour F, Sakai K, Hatsushikano S, Le Huec JC, Hasegawa K. Sagittal balance measures are more reproducible when measured in 3D vs in 2D using full-body EOS® images. Eur Radiol 2018; 28:4570-4577. [DOI: 10.1007/s00330-018-5485-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 11/30/2022]
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Lowered dose full-spine radiography in pediatric patients with idiopathic scoliosis. 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 2018; 27:1089-1095. [PMID: 29589171 DOI: 10.1007/s00586-018-5561-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To optimize our standard full-spine radiography with respect to diagnostic quality and dose. METHODS A phantom study was performed to establish an optimal posterior-anterior view (PA) full spine protocol having the lowest dose with non-inferior quality compared to standard. We then applied this protocol in 40 pediatric patients (group B). The radiographs were scored on six criteria by a pediatric radiologist and orthopedist and compared to the scores of 40 PA full spine radiographs performed in 2013 with standard protocol (group A). Radiation dose was assessed by dose area product (DAP) and effective dose (E). Statistical analysis included independent samples t test, Mann-Whitney U test and intra-class correlation coefficient (ICC). RESULTS An optimized protocol was defined (0.2 mm Cu filter, 0.87 relative exposure, with grid). Mean age was 13.3 ± 1.6 years for group A and 13.4 ± 1.7 years for group B. For group B, the mean DAP was 47.0 µGy m2 with an E of 0.13 mSv. For group A, the mean DAP was 85.3 µGy m2 with an E of 0.24 mSv. This represents a dose reduction of 45%. Mean image quality scores for group A (27.9 ± 2.4) and group B (28.1 ± 2.3) were similar (p = 0.612). Interobserver agreement was observed to be excellent (ICC 0.92). CONCLUSION This study demonstrates that a low-dose full-spine radiograph can be performed in patients with idiopathic scoliosis without loss of image quality. These slides can be retrieved under Electronic Supplementary Material.
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Organ doses and lifetime attributable risk evaluations for scoliosis examinations of adolescent patients with the EOS imaging system. Radiol Med 2017; 123:305-313. [PMID: 29164365 DOI: 10.1007/s11547-017-0828-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The goal of this work is to evaluate organ doses and lifetime attributable risk of cancer incidence and mortality in scoliosis examinations of adolescent patients performed with EOS imaging system, in order to optimize patient dose and protocols. METHODS An anthropomorphic phantom of a normal patient, with thermoluminescent dosimeters in correspondence with the main organs at risk, was imaged with both EOS and computed radiography (CR). For each modality, effective dose was calculated from the measured organ doses. Lifetime attributable risk was computed accordingly to the Committee on the Biological Effects of Ionizing Radiation (BEIR VII) and Public Health England (HPA) publications. RESULTS Except for testes and eyes, which were excluded from the scan in CR protocol, for all the other organs the doses delivered with CR examination were higher than these delivered by EOS system. The effective dose in EOS examination (0.43 ± 0.04 mSv) is about two times less than the dose in computed radiography with anti-scatter grid examination (0.87 ± 0.09 mSv), and, consequently, also the cancer probability is lower (5.4 vs 9.7 number of any cancers induction cases per 100,000 person examined, for a 20-year-old male patient). CONCLUSIONS The EOS system is efficient in limiting patient dose. The shielding of testes and the exclusion of eyes from the scan could allow to further reduce the dose.
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Cheung JPY, Cahill P, Yaszay B, Akbarnia BA, Cheung KMC. Special article: Update on the magnetically controlled growing rod: tips and pitfalls. J Orthop Surg (Hong Kong) 2015; 23:383-90. [PMID: 26715724 DOI: 10.1177/230949901502300327] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Magnetically controlled growing rods (MCGR) have become an important treatment option in young patients with spinal deformities. This device allows for gradual lengthening on an outpatient setting with continuous neurological monitoring in an awake patient. With its growing popularity and interest, this study reports the tips, pitfalls, and complications of the MCGR for management of scoliosis. On 3 June 2015 at the University of Hong Kong, 32 participants from 16 regions shared their experience with MCGR. Current indications for surgery include early-onset scoliosis patients. Adolescent idiopathic scoliosis and congenital scoliosis patients have less favourable outcomes. The number of instrumented levels should be minimised, as all instrumented levels must be included in the definitive fusion surgery. Rod contouring is important and owing to the straight portion of the rod housing the magnet, there is limited proximal rod portion for proper contouring, which may predispose to proximal junctional kyphosis. There is currently no consensus on the rod configuration, timing, frequency, technique, and amount of distraction. Risk factors for distraction failure include larger patients, internal magnets too close to each other, and magnets too close to the apex of the major curve. Future studies should resolve the issues regarding the technique of distraction, optimal frequency and amount of distraction per session. More comprehensive cost analyses should be performed.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Patrick Cahill
- Shriners Hospitals for Children, Philadelphia, Pennsylvania, United States
| | - Burt Yaszay
- Pediatric Orthopedic and Scoliosis Center, San Diego, California, United States
| | - Behrooz A Akbarnia
- San Diego Center for Spinal Disorders, La Jolla, California, United States
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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