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Pham TT, Le LH, Khodaei M, Zheng R, Lou E. Investigation of ultrasonic soft tissue-bone reflection coefficients correlating with curve severity in children with adolescent idiopathic scoliosis. Proc Inst Mech Eng H 2022; 236:1403-1413. [PMID: 35880904 PMCID: PMC9449449 DOI: 10.1177/09544119221114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional curvature of spine.
Children with AIS and low bone quality have higher chance to get curve
progression leading to bigger spinal curvature. In addition, bone quality
affects acoustic impedance of bone, thus influencing the reflection coefficient
of ultrasound signal from the soft tissue–bone interface. This study aimed to
estimate the bone quality of AIS patients based on the reflection coefficients
to determine the correlation of the bone quality with curve severity. A simple
bone model was used to develop an equation to calculate the reflection
coefficient value. Experiments were conducted on five different phantoms.
Acrylic was used to design a vertebral shape to study the effect of surface
roughness and inclination, including: smooth flat surface (SFS), smooth curved
surface (SCS), rough curved surface (RCS), and the rough curved inclined surface
(RCIS). A clinical study with 37 AIS patients were recruited. The estimated
reflection coefficient values of plate phantoms agreed well with the predicted
values and the maximum error was 6.7%. The reflection coefficients measured from
the acrylic-water interface for the SFS, SCS, RCS, RCIS (3° and 5°) were 0.37,
0.33, 0.28, (0.23 and 0.12), respectively. The surface roughness and inclination
increased the reflection loss. From the clinical data, the average reflection
coefficients for children with AIS were 0.11 and 0.07 for the mild curve group
and the moderate curve group, respectively. A moderate linear correlation was
found between the reflection coefficients and curve severity (r2 = 0.3). Patients with lower bone quality have observed to have
larger spinal curvature.
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Affiliation(s)
- Thanh-Tu Pham
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mahdieh Khodaei
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Rui Zheng
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Edmond Lou
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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Readford TR, Hayes M, Reed WM. Factors affecting chiropractor requests for full-length spinal radiography: A scoping review. J Med Radiat Sci 2022; 69:236-249. [PMID: 34995416 PMCID: PMC9163483 DOI: 10.1002/jmrs.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022] Open
Abstract
Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue. The purpose of this scoping review was to explore the issues surrounding the utilisation of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence. A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted using keywords. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesised using a narrative approach. In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings. This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence of published guidelines for spinal imaging, an absence of a reporting mechanism for the utilisation of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography. Further investigation is required to further understand the scope of this issue and its impacts for radiation protection and patient safety.
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Affiliation(s)
- Thomas R. Readford
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Melanie Hayes
- Discipline of Work Integrated Learning, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Warren Michael Reed
- Medical Imaging Optimisation and Perception Group (MIOPeG), Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
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Kim JH, Yum TH, Shim JS. Secondary Cervicothoracic Scoliosis in Congenital Muscular Torticollis. Clin Orthop Surg 2019; 11:344-351. [PMID: 31475057 PMCID: PMC6695322 DOI: 10.4055/cios.2019.11.3.344] [Citation(s) in RCA: 9] [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: 01/30/2019] [Revised: 03/04/2019] [Accepted: 04/10/2019] [Indexed: 11/08/2022] Open
Abstract
Background Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. Methods Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. Results All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p < 0.001). The improvement of Cobb angle was significantly higher in age ≤ 15 years than in age > 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. Conclusions The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Hoon Yum
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Sup Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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Radiation dose for pediatric scoliosis patients undergoing whole spine radiography: Effect of the radiographic length in an auto-stitching digital radiography system. Eur J Radiol 2018; 108:99-106. [DOI: 10.1016/j.ejrad.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/04/2018] [Accepted: 09/12/2018] [Indexed: 01/10/2023]
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Di Iorgi N, Maruca K, Patti G, Mora S. Update on bone density measurements and their interpretation in children and adolescents. Best Pract Res Clin Endocrinol Metab 2018; 32:477-498. [PMID: 30086870 DOI: 10.1016/j.beem.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following the increased awareness about the central role of the pediatric age in building bone for life, clinicians face more than ever the necessity of assessing bone health in pediatric subjects at risk for early bone mass derangements or in healthy children, in order to optimize their bone mass accrual and prevent osteoporosis. Although the diagnosis of osteoporosis is not made solely upon bone mineral density measurements during growth, such determination can be very useful in the follow-up of pediatric patients with primary and secondary osteoporosis. The ideal instrument would give information on the mineral content and density of the bone, and on its architecture. It should be able to perform the measurements on the skeletal sites where fractures are more frequent, and it should be minimally invasive, accurate, precise and rapid. Unfortunately, none of the techniques currently utilized fulfills all requirements. In the present review, we focus on the pediatric use of dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), and magnetic resonance imaging (MRI), highlighting advantages and limits for their use and providing indications for bone densitometry interpretation and of vertebral fractures diagnosis in pediatric subjects.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
| | - Katia Maruca
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Stefano Mora
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy.
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Muharemovic O, Troelsen A, Thomsen MG, Kallemose T, Gosvig KK. The effect of personalized versus standard patient protocols for radiostereometric analysis (RSA). Radiography (Lond) 2018; 24:e31-e36. [PMID: 29605122 DOI: 10.1016/j.radi.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increasing pressure in the clinic requires a more standardized approach to radiostereometric analysis (RSA) imaging. The aim of this study was to investigate whether implementation of personalized RSA patient protocols could increase image quality and decrease examination time and the number of exposure repetitions. METHODS Forty patients undergoing primary total hip arthroplasty were equally randomized to either a case or a control group. Radiographers in the case group were assisted by personalized patient protocols containing information about each patient's post-operative RSA imaging. Radiographers in the control group used a standard RSA protocol. RESULTS At three months, radiographers in the case group significantly reduced (p < 0.001) the number of exposures by 1.6, examination time with 19.2 min, and distance between centrum of prosthesis and centrum of calibration field with 34.1 mm when compared to post-operative (baseline) results. At twelve months, the case group significantly reduced (p < 0.001) number of exposures by two, examination time with 22.5 min, and centrum of prosthesis to centrum of calibration field distance with 43.1 mm when compared to baseline results. No significant improvements were found in the control group at any time point. CONCLUSION There is strong evidence that personalized RSA patient protocols have a positive effect on image quality and radiation dose savings. Implementation of personal patient protocols as a RSA standard will contribute to the reduction of examination time, thus ensuring a cost benefit for department and patient safety.
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Affiliation(s)
- O Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. mailto:
| | - A Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - M G Thomsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - T Kallemose
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - K K Gosvig
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
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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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Kim JS, Yoon SW, Seo DN, Nam SR, Kim JM. Evaluation of the Patient Effective Dose in Whole Spine Scanography Based on the Automatic Image Pasting Method for Digital Radiography. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e22514. [PMID: 27110338 PMCID: PMC4835671 DOI: 10.5812/iranjradiol.22514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/14/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whole spine scanography (WSS) is a radiologic examination that requires whole body X-ray exposure. Consequently, the amount of patient radiation exposure is higher than the radiation dose following routine X-ray examination. OBJECTIVES Several studies have evaluated the patient effective dose (ED) following single exposure film-screen WSS. The objective of this study was to evaluate patient ED during WSS, based on the automatic image pasting method for multiple exposure digital radiography (APMDR). Further, the calculated EDs were compared with the results of previous studies involving single exposure film-screen WSS. PATIENTS AND METHODS We evaluated the ED of 50 consecutive patients (M:F = 28:22) who underwent WSS using APMDR. The anterior-posterior (AP) and lateral (LAT) projection EDs were evaluated based on the Monte Carlo simulation. RESULTS Using APMDR, the mean number of exposures was 6.1 for AP and 6.5 for LAT projections. LAT projections required more exposures (6.55%) than AP projections. The mean ED was 0.6276 mSv (AP) and 0.6716 mSv (LAT). The mean ED for LAT projections was 0.6061 mSv in automatic exposure control (AEC) and 0.7694 mSv in manual mode. The relationship between dose-area-product (DAP) and ED revealed a proportional correlation (AP, R(2) = 0.943; LAT, R(2) = 0.773). Compared to prior research involving single exposure screen-film WSS, the patient ED following WSS using APMDR was lower on AP than on LAT projections. CONCLUSION Despite multiple exposures, ED control is more effective if WSS is performed using APMDR in the AEC mode.
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Affiliation(s)
- Jung-Su Kim
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - Sang-Wook Yoon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, South Korea
| | - Deok-Nam Seo
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - So-Ra Nam
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
| | - Jung-Min Kim
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea
- Corresponding author: Jung-Min Kim, Department of Radiologic Science, College of Health Science, Korea University, Seoul, South Korea. Tel: +82-2940-2577, Fax: +82-29402829, E-mail:
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11
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Law M, Ma WK, Lau D, Chan E, Yip L, Lam W. Cumulative radiation exposure and associated cancer risk estimates for scoliosis patients: Impact of repetitive full spine radiography. Eur J Radiol 2016; 85:625-8. [PMID: 26860676 DOI: 10.1016/j.ejrad.2015.12.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To quantitatively evaluate the cumulative effective dose and associated cancer risk for scoliotic patients undergoing repetitive full spine radiography during their diagnosis and follow up periods. METHODS Organ absorbed doses of full spine exposed scoliotic patients at different age were computer simulated with the use of PCXMC software. Gender specific effective dose was then calculated with the ICRP-103 approach. Values of lifetime attributable cancer risk for patients exposed at different age were calculated for both patient genders and for Asian and Western population. Mathematical fitting for effective dose and for lifetime attributable cancer risk, as function of exposed age, was analytically obtained to quantitatively estimate patient cumulated effective dose and cancer risk. RESULTS The cumulative effective dose of full spine radiography with posteroanterior and lateral projection for patients exposed annually at age between 5 and 30 years using digital radiography system was calculated as 15mSv. The corresponding cumulative lifetime attributable cancer risk for Asian and Western population was calculated as 0.08-0.17%. Female scoliotic patients would be at a statistically significant higher cumulated cancer risk than male patients under the same full spine radiography protocol. CONCLUSION We demonstrate the use of computer simulation and analytic formula to quantitatively obtain the cumulated effective dose and cancer risk at any age of exposure, both of which are valuable information to medical personnel and patients' parents concern about radiation safety in repetitive full spine radiography.
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Affiliation(s)
- Martin Law
- Department of Radiology, Queen Mary Hospital, Hong Kong.
| | - Wang-Kei Ma
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Damian Lau
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Eva Chan
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Lawrance Yip
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Wendy Lam
- Department of Radiology, Queen Mary Hospital, Hong Kong
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Li M, Cheng J, Ying M, Ng B, Lam TP, Wong MS. A Preliminary Study of Estimation of Cobb's Angle From the Spinous Process Angle Using a Clinical Ultrasound Method. Spine Deform 2015; 3:476-482. [PMID: 27927534 DOI: 10.1016/j.jspd.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Over a lifetime of having radiographs, a patient with adolescent idiopathic scoliosis (AIS) can be cumulatively exposed to high doses of ionizing radiation. Therefore, radiation-free, effective, and low-cost methods to screen and diagnose scoliosis have been sought for years. PURPOSE This study aims to investigate the correlation between the Cobb's angle and the spinous process angle (SPA) and to study the feasibility of using clinical ultrasound images to estimate the Cobb's angle by measuring the SPA. STUDY DESIGN This manuscript includes a retrospective and a prospective study. METHODS In the retrospective study, radiographs from 43 subjects with AIS were used to investigate the correlation between the Cobb's angle and the SPA at the pre-brace and in-brace stages. Following this study, a prospective clinical ultrasound study was conducted on 33 subjects with AIS at the pre-brace stage to measure the SPA. RESULTS High intra-rater and inter-rater reliabilities of radiograph measurements were found (ICC[3,3] = 0.97, ICC[2,3] = 0.91, p < .05). The clinical ultrasound measurements were also found to be highly reliable (ICC[3,3] = 0.91, p < .05). There was a significant correlation (r = 0.80 at the pre-brace stage and r = 0.87 at the in-brace stage, p < .05) between the Cobb's angle and the SPA measured from the radiograph measurements, whereas the SPA measured from ultrasound images were found highly correlated with that measured from the radiographs at the pre-brace stage (r = 0.90, p < .01). CONCLUSIONS The findings of this study could support the new parameter (SPA) in the estimation of the Cobb's angle of a scoliotic curve in the coronal plane, and clinical ultrasound imaging could be developed and applied to assess scoliosis in a fast and noninvasive fashion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Meng Li
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, PR China
| | - Jack Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Michael Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, PR China
| | - Bobby Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Man-Sang Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong SAR, PR China.
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Are routine postoperative radiographs necessary during the first year after posterior spinal fusion for idiopathic scoliosis? A retrospective cohort analysis of implant failure and surgery revision rates. J Pediatr Orthop 2015; 35:33-8. [PMID: 24840654 DOI: 10.1097/bpo.0000000000000219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiographs are routinely obtained at postoperative visits during the first year after posterior spinal fusion (PSF) for idiopathic scoliosis (IS). The goal of this study was to determine how often radiographic findings change postoperative care. METHODS A total of 227 consecutive patients aged 10 to 21 years who underwent surgery for IS at our institution from 2004 to 2010 were identified. Charts were reviewed to determine the frequency of the following clinical symptoms during the first year after surgery: pain greater than expected, implant prominence, and sensory/motor disturbance. Radiographs were reviewed to identify implant failure and curve change. Logistic regression analysis was used to identify clinical symptoms associated with treatment deviation. RESULTS During the first year after surgery, an average of 6 (range, 2 to 12) radiographs were obtained from patients during an average of 3 (range, 2 to 10) follow-up visits. Pain (14%) was the most common symptom. Neurologic symptoms (13%) and implant prominence (4%) were less common. Implant failure was identified in 4 subjects (2%), of which 3 required revision surgery. The incidence of revision surgery was 2.9/1000 radiographs (95% confidence interval, 0.6-8.3). Curve progression >5 degrees in the uninstrumented curve occurred in 2 patients (0.9%). Curve progression did not result in a change in treatment for any of the patients. Pain was the only clinical symptom associated with implant failure (P=0.0047). 169/227 patients did not have any symptoms and only one of these underwent revision surgery. The sensitivity of a clinical test, which uses the presence of pain to guide the need for radiographic evaluation and rule out implant failure, was 75%, specificity 87%, positive predictive value 10%, and negative predictive value 99.5%. CONCLUSIONS After obtaining baseline postoperative radiographs, additional radiographs during the first year after surgery for IS may not be required in the absence of clinical symptoms. Reducing the number of radiographs taken during the first year after surgery for IS in patients without symptoms can reduce radiation exposure to patients and health care costs without affecting treatment. LEVEL OF EVIDENCE Level II, Diagnostic Study.
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De Korvin G, Randriaminahisoa T, Cugy E, Cheze L, de Sèze M. Detection of progressive idiopathic scoliosis during growth using back surface topography: A prospective study of 100 patients. Ann Phys Rehabil Med 2014; 57:629-39. [DOI: 10.1016/j.rehab.2014.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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Pace N, Ricci L, Negrini S. A comparison approach to explain risks related to X-ray imaging for scoliosis, 2012 SOSORT award winner. SCOLIOSIS 2013; 8:11. [PMID: 23819852 PMCID: PMC3710473 DOI: 10.1186/1748-7161-8-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 06/17/2013] [Indexed: 11/23/2022]
Abstract
Background X-ray imaging is frequently used as diagnostic approach for scoliosis in children and adolescents. X-ray procedures are considered as justified only when expected benefits exceed related risks. While benefits are well known to physicians, radiological risk awareness can be vague, impeding an optimal communication with patients’ parents and possibly leading to discomfort and anxiety. Objective of the study is the suggestion of a risk comparison approach for better communicating the radiological risks related to X-ray investigation of scoliosis. Methods Starting point of the analysis is the Linear Non-Threshold (LNT) assumption for radiation stochastic effect, which states that for effective doses (E, Sievert – Sv) below 100 mSv, the probability of future stochastic damage is linearly related to E: absorbing two E’s in separate moments results in the addition of the risks related to each E. This allows to add E from different sources to calculate a cumulative risk of health detriment. Medline (Pubmed) was systematically searched in order to determine the average E delivered during X-ray investigation of scoliosis. Subsequently, the major natural sources of radiation were considered. The average yearly E due to natural sources was compared with E due to the imaging of the vertebral column. Results E’s due to X-ray scoliosis examinations show a large variability: under 7 years of age, 0.03-0.54 mSv; 7–12 years, 0.11-0.80 mSv; 13–18 years, 0.17-1.09 mSv. Overall, 65% of the world population is expected to be exposed to an annual E between 1 and 3 mSv. More in detail, worldwide the total annual average E due to natural sources is 2.4 mSv (range 1–10), of which half originates from Radon exposure. Other sources are cosmic rays and ingestion and inhalation of radionuclides. For example, one flight between Europe and America accounts for 0.030-0.045 mSv because of exposure to cosmic rays. Conclusions X-rays are carcinogenic and exposures to them always need to be justified and optimized in order to minimize the risks of health effects. However, the human body is continuously struck by radiations coming from natural sources. A useful element of comparison to evaluate E due to medical exposures in scoliosis can be then provided by the amount of E coming from natural sources. This comparison approach can play a role in the relationship between physicians and patients’ parents and lead to an improved awareness in patients’ parents.
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Affiliation(s)
- Nicola Pace
- BIOtech - Interdepartmental Center on Biomedical Technologies, Università di Trento, Trento, I-38100 Italy.
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