1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF, Mehlman CT, Milbrandt TA, Newton PO, Price N, Sanders JO, Schmitz ML, Schwend RM, Shah SA, Song K, Talwalkar V. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:147-156. [PMID: 37994691 PMCID: PMC10841822 DOI: 10.1097/brs.0000000000004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
STUDY DESIGN Prospective multicenter study data were used for model derivation and externally validated using retrospective cohort data. OBJECTIVE Derive and validate a prognostic model of benefit from bracing for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated the superiority of bracing over observation to prevent curve progression to the surgical threshold; 42% of untreated subjects had a good outcome, and 28% progressed to the surgical threshold despite bracing, likely due to poor adherence. To avoid over-treatment and to promote patient goal setting and adherence, bracing decisions (who and how much) should be based on physician and patient discussions informed by individual-level data from high-quality predictive models. MATERIALS AND METHODS Logistic regression was used to predict curve progression to <45° at skeletal maturity (good prognosis) in 269 BrAIST subjects who were observed or braced. Predictors included age, sex, body mass index, Risser stage, Cobb angle, curve pattern, and treatment characteristics (hours of brace wear and in-brace correction). Internal and external validity were evaluated using jackknifed samples of the BrAIST data set and an independent cohort (n=299) through estimates of discrimination and calibration. RESULTS The final model included age, sex, body mass index, Risser stage, Cobb angle, and hours of brace wear per day. The model demonstrated strong discrimination ( c -statistics 0.83-0.87) and calibration in all data sets. Classifying patients as low risk (high probability of a good prognosis) at the probability cut point of 70% resulted in a specificity of 92% and a positive predictive value of 89%. CONCLUSION This externally validated model can be used by clinicians and families to make informed, individualized decisions about when and how much to brace to avoid progression to surgery. If widely adopted, this model could decrease overbracing of AIS, improve adherence, and, most importantly, decrease the likelihood of spinal fusion in this population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kit Song
- Carelon Health Services and the University of California, Los Angeles, CA
| | | |
Collapse
|
3
|
Del Prete CM, Tarantino D, Viva MG, Murgia M, Vergati D, Barassi G, Sparvieri E, Di Stanislao E, Perpetuini D, Russo EF, Filoni S, Pellegrino R. Spinal Orthosis in Adolescent Idiopathic Scoliosis: An Overview of the Braces Provided by the National Health Service in Italy. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:3. [PMID: 38276037 PMCID: PMC10818494 DOI: 10.3390/medicina60010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the most common form of scoliosis in the pediatric population. The etiology is multifactorial, including genetic and environmental factors. The incidence is roughly equal between males and females, while there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we carried out a review of the scientific literature about the indication and success rates of the braces provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment is present in the scientific literature, demonstrating a high degree of variability. The overall success rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.
Collapse
Affiliation(s)
| | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Mattia Giuseppe Viva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, 00183 Rome, Italy; (M.G.V.); (M.M.)
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, 00183 Rome, Italy; (M.G.V.); (M.M.)
| | | | - Giovanni Barassi
- Center for Physiotherapy, Rehabilitation and Re-Education-CeFiRR-Gemelli Molise, 86100 Campobasso, Italy;
| | | | | | - David Perpetuini
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy;
| | | | - Serena Filoni
- I.R.R.C.S. Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano–Pazzallo, Switzerland;
- Santa Chiara Institute, 73100 Lecce, Italy
| |
Collapse
|
4
|
Hoelen TCA, de Bie RA, Arts JJ, Willems PC. Methodology and application of three-dimensional technology for brace design and production for treatment in patients with adolescent idiopathic scoliosis: a scoping review protocol. BMJ Open 2023; 13:e079673. [PMID: 38070915 PMCID: PMC10729142 DOI: 10.1136/bmjopen-2023-079673] [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: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Conservative treatment for adolescent idiopathic scoliosis (AIS) using bracing has proven to be effective at reducing curve progression. However, variation in brace design and lack of brace specificity hamper clinical treatment outcomes as well as the predictability and comparison hereof. To overcome this, recent technological developments aim to generate transparent and objective criteria for brace manufacturing by applying computer-aided design software and additive manufacturing to produce braces for scoliosis treatment. Yet, the extent of its applicability and clinical implementation are to be determined. This study will identify and map the available evidence for the methodology and application of three-dimensional technology for the design and production of clinical braces used for treatment in patients with AIS. METHODS AND ANALYSIS This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. This scoping review will consider studies on methodology of three-dimensional technological methodology and applications that have been or are currently being applied in brace treatment of AIS. The following databases will be searched: MEDLINE, Web of Science, Cochrane Database of Systematic Reviews and Embase (OVID). Search limits will be applied; for example, only articles written in the English language published after 2000 will be included. The retrieved articles will be screened independently by two researchers. A third researcher will be consulted in case of disagreement. Data from relevant articles will be independently extracted by two researchers and presented in a tabular manner accompanied by a descriptive narration. ETHICS AND DISSEMINATION Considering the nature of the study, no ethical approval needed to be requested. The study result will be submitted to a peer-reviewed journal.
Collapse
Affiliation(s)
- Thomáy-Claire Ayala Hoelen
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology and CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jacobus Jc Arts
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Bizzoca D, Piazzolla A, Moretti L, Vicenti G, Moretti B, Solarino G. Anterior vertebral body tethering for idiopathic scoliosis in growing children: A systematic review. World J Orthop 2022; 13:481-493. [PMID: 35633741 PMCID: PMC9125003 DOI: 10.5312/wjo.v13.i5.481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/01/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of idiopathic scoliosis (IS) in skeletally immature patients should aim at three-dimensional deformity correction, without compromising spinal and chest growth. In 2019, the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering (AVBT), under a Humanitarian Device Exception, for skeletally immature patients with curves having a Cobb angle between 35° and 65°.
AIM To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.
METHODS From January 2014 to January 2021, Ovid Medline, Embase, Cochrane Library, Scopus, Web of Science, Google Scholar and PubMed were searched to identify relevant studies. The methodological quality of the studies was evaluated and relevant data were extracted.
RESULTS Seven clinical trials recruiting 163 patients were included in the present review. Five studies out of seven were classified as high quality, whereas the remaining two studies were classified as moderate quality. A total of 151 of 163 AVBT procedures were performed in the thoracic spine, and the remaining 12 tethering in the lumbar spine. Only 117 of 163 (71.8%) patients had a nonprogressive curve at skeletal maturity. Twenty-three of 163 (14.11%) patients required unplanned revision surgery within the follow-up period. Conversion to posterior spinal fusion (PSF) was performed in 18 of 163 (11%) patients.
CONCLUSION AVBT is a promising growth-friendly technique for treatment of IS in growing patients. However, it has moderate success and perioperative complications, revision and conversion to PSF.
Collapse
Affiliation(s)
- Davide Bizzoca
- UOSD Spinal Deformity Centre, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari 70124, Italy
| | - Andrea Piazzolla
- UOSD Spinal Deformity Centre, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Lorenzo Moretti
- Orthopaedic and Trauma Unit, AUO Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy
| | - Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy
| |
Collapse
|
7
|
Babaee T, Kamyab M, Ganjavian MS, Rouhani N, Khorramrouz A, Jarvis JG. Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis. Spine Deform 2022; 10:543-551. [PMID: 35034344 DOI: 10.1007/s43390-021-00452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS). METHODS In this retrospective multicenter study, the patient's sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up. RESULTS A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11. CONCLUSION C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA.
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naeimeh Rouhani
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Adel Khorramrouz
- Department of Electrical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - James G Jarvis
- Division of Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| |
Collapse
|
8
|
Athawale V, Phansopkar P, Darda P, Chitale N, Chinewar A. Impact of Physical Therapy on Pain and Function in a Patient With Scoliosis. Cureus 2021; 13:e15261. [PMID: 34188999 PMCID: PMC8232979 DOI: 10.7759/cureus.15261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Human spine is a complex and robust structure. Almost all spine deformities contribute to limitations in activities of daily living. Scoliosis is the most common deformity accompanied by rotation and progresses during the growth of an individual. It is classified into three categories: congenital, idiopathic, and neuromuscular. The common secondary causes of scoliosis include cerebral palsy, poliomyelitis, and other neuromuscular conditions. A case of a 23-year-old female with right shoulder pain with a history of adolescent idiopathic scoliosis, which leads to a decrease in self-image and disturbance in activities of daily living, is presented in this report. The assessment, medical history, and rehabilitation protocol are mentioned in this case report. Physical therapy to treat shoulder joints includes thermotherapy and manual therapy targeting pain over the joint and stiffness. The use of thermotherapy, bracing, and strengthening and stretching exercises to prevent further deformity and aggravation of the symptoms is described in this report. We report that there was a significant improvement in muscle strength, relief from pain, spinal mobility, postural control, and decreases in further complications.
Collapse
Affiliation(s)
- Vrushali Athawale
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Palak Darda
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Neha Chitale
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashvini Chinewar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|