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Parret C, Herman F, Cyteval C, Pastor M. EOSedge vs. standard digital radiography: image quality and dose exposure in hip-focused scanning. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05478-0. [PMID: 39153100 DOI: 10.1007/s00402-024-05478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES To compare the image quality and X-ray exposure dose from EOSedge versus standard digital radiography (SDR) focused on the hip for replacement or prosthesis revision surgery. MATERIALS & METHODS This prospective single centre study included 97 patients between November 2022 and April 2023. For preoperative assessment, SDR radiographs from frontal pelvic and hip profile were indispensable. Often, surgeon requested spine radiograph from EOSedge, to which we added frontal pelvic and hip profile. A radiologist with 4 years' experience established a score based on European guidelines to evaluate the EOSedge versus SDR image quality. Quality scores (QS) were compared using paired Student's t test. The entrance skin dose (ESD) and dose area product (DAP) of the images were recorded. RESULTS A total of 97 patients, including 49 women and 48 men (mean 68.10 years ± 13.28) were assessed. The QSEOSedge was significantly higher than the QSSDR, with differences of 1.34 ± 1.90 (p < 0.001) and 1.74 ± 1.90 (p < 0.001), respectively. The difference in total QS was 3.08 ± 3.48 (p < 0.001). The radiation delivered (ESD x DAP) by EOSedge was 29 times lower than that delivered by SDR for frontal pelvic imaging (0.35 ± 0.91 versus 10.20 ± 12.63; p < 0.001) and 17 times lower for hip profile imaging (0.41 ± 0.84 versus 6.91 ± 9.70; p < 0.001). CONCLUSION This study highlighted the superior image quality of EOSedge images focused on the pelvis and hip compared to SDR, with significantly less radiation exposure.
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Affiliation(s)
- Camille Parret
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, Montpellier, France
| | - Fanchon Herman
- Clinical Research and Epidemiology section, Montpellier University Hospital, Montpellier, France
| | - Catherine Cyteval
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, Montpellier, France
| | - Maxime Pastor
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, Montpellier, France.
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Orellana KJ, Bram JT, Batley M, Novotny S, Shah H, Laine JC, Kelly DM, Martin B, Schrader T, Kim H, Sankar WN. Predictors of Persistent Limp Following Proximal Femoral Varus Osteotomy for Perthes Disease. J Pediatr Orthop 2024; 44:e618-e624. [PMID: 38659309 DOI: 10.1097/bpo.0000000000002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION One of the most popular containment procedures for Legg-Calvé-Perthes disease (LCPD) is proximal femur varus osteotomy (PFO). While generally successful in achieving containment, PFO can cause limb length discrepancy, abductor weakness, and (of most concern for families) a persistent limp. While many studies have focused on radiographic outcomes following containment surgery, none have analyzed predictors of this persistent limp. The aim of this study was to determine clinical, radiographic, and surgical risk factors for persistent limp 2 years after PFO in children with LCPD. METHODS A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 years at disease onset with unilateral early-stage LCPD (Waldenström I) who underwent PFO. Limp status (no, mild, and severe), age, BMI, and pain scores were obtained at initial presentation, 3-month, and 2-year postoperative visits. Preoperative and follow-up radiographs were used to measure traditional morphologic hip metrics including acetabular index (AI), lateral center-edge angle (LCEA), and femoral neck-shaft angle (NSA). Univariate analysis as well as multivariate logistic regression models were used to analyze factors associated with mild and severe limp at the 2-year visit. RESULTS A total of 95 patients met the inclusion criteria, and of these 50 patients underwent concomitant greater trochanter apophysiodesis (GTA) at the time of PFO. At the 2-year visit, there were 38 patients (40%) with a mild or severe limp. Multivariate logistic regression revealed no significant radiographic factors associated with a persistent limp. However, lower 2-year BMI and undergoing GTA were associated with decreased rates of persistent limp regardless of age ( P <0.05). When stratifying by age of disease onset, apophysiodesis appeared to be protective against any severity of limp in patients aged 6 to 8 years old ( P = 0.03), but not in patients 8 years or older ( P = 0.49). CONCLUSIONS Persistent limp following PFO is a frustrating problem that was seen in 40% of patients at 2 years. However, lower follow-up BMI and performing a greater trochanter apophysiodesis, particularly in patients younger than 8 years of age, correlated with a lower risk of postoperative limp.
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Affiliation(s)
- Kevin J Orellana
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joshua T Bram
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Morgan Batley
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan Novotny
- Department of Orthopaedic Surgery, Gillete Children's Specialty Healthcare, St. Paul
| | - Hitesh Shah
- Department of Paediatric Orthopaedics, Kasturba Medical College, Karnataka, Manipal, India
| | - Jennifer C Laine
- Department of Orthopaedic Surgery, Gillete Children's Specialty Healthcare, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Derek M Kelly
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN
| | - Benjamin Martin
- Department of Orthopaedic Surgery, Division of Orthopaedic Surgery & Sports Medicine, Children's National Hospital, Washington, DC
| | - Tim Schrader
- Department of Orthopaedic Surgery, Children's Healthcare Atlanta, Atlanta, GA
| | - Harry Kim
- Department of Orthopaedic Surgery, Texas Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wudbhav N Sankar
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Ben-Ari E, Shichman I, Sissman E, Oakley C, Hepinstall M, Schwarzkopf R. Calibration of magnification in two-dimensional low-dose full-body imaging for preoperative planning of total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6875-6881. [PMID: 37340223 DOI: 10.1007/s00402-023-04926-7] [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: 01/11/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Preoperative planning of total hip arthroplasty (THA) using two-dimensional low-dose (2DLD) full-body imaging has gained popularity in recent years. The low-dose imaging system is said to produce a calibrated image with constant 1:1 magnification. However, the planning software used in conjunction with those images may introduce variations in the degree of magnification in 2DLD imaging, and this has not yet been investigated. The purpose of the present study was to quantify any variation in 2DLD image to assess the need for image calibration when using conventional planning software. METHODS Postoperative 2DLD images from 137 patients were retrospectively evaluated. Only patients who underwent THA for primary osteoarthritis were included in the study cohort. The femoral head diameter was measured by two independent observers using both Orthoview™ and TraumaCad™ planning software programs. Actual sizes of the femoral head implants were extracted from surgical reports to calculate image magnification. Magnification measurement reliability was calculated with the intra-class correlation coefficient (ICC) index. RESULTS Image magnification varied among cases (mean 133%, range 129-135%). There was no statistical difference in mean image magnification among the various implant sizes (p = 0.8). Mean observer and inter-observer reliability was rated excellent. CONCLUSION THA planning with 2DLD imaging is subject to variation in magnification as analyzed with conventional planning software in this series. This finding is of paramount importance for surgeons using 2DLD imaging in preparation for THA since errors in magnification could affect the accuracy of preoperative planning and ultimately the clinical outcome.
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Affiliation(s)
- Erel Ben-Ari
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Ittai Shichman
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ethan Sissman
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Christian Oakley
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Matthew Hepinstall
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
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Pacult MA, Walker CT, Godzik J, Turner JD, Uribe JS. Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms. Oper Neurosurg (Hagerstown) 2021; 21:S39-S45. [PMID: 34128066 DOI: 10.1093/ons/opaa324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk. Several mitigating techniques have arisen in recent years, ranging from lead protection to radiation-reducing protocols, although each technique has limits. A hitherto-problematic barrier has been the fact that efforts to diminish radiation emission come at the cost of reduced image quality. OBJECTIVE To describe new ultra-low radiation imaging modalities that have the potential to drastically reduce radiation risk and minimize unacceptable adverse effects. METHODS A literature review was performed of articles and studies that used either of 2 ultra-low radiation imaging modalities, the EOS system (EOS-Imaging S.A., Paris, France) and LessRay (NuVasive, San Diego, CA). RESULTS Both ultra-low radiation imaging modalities reduce radiation exposure in the preoperative and perioperative settings. EOS provides 3-dimensional reconstructive capability, and LessRay offers intraoperative tools that facilitate spinal localization and proper visual alignment of the spine. CONCLUSION These novel radiation-reducing technologies diminish patient and surgeon exposure, aid the surgeon in preoperative planning, and streamline intraoperative workflow.
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Affiliation(s)
- Mark A Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Selberg CM, Bram JT, Carry P, Goldstein RY, Schrader T, Laine JC, Kim HKW, Sankar WN. Hip Morphology in Early-stage LCPD: Is There an Argument for Anatomic-specific Containment? J Pediatr Orthop 2021; 41:344-351. [PMID: 33843788 DOI: 10.1097/bpo.0000000000001791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early containment surgery has become increasingly popular in Legg-Calvé-Perthes Disease (LCPD), especially for older children. These procedures treat the proximal femur, the acetabulum, or both, and most surgeons endorse the same surgical option regardless of an individual patient's anatomy. This "one-surgery-fits-all" approach fails to consider potential variations in baseline anatomy that may make one option more sensible than another. We sought to describe hip morphology in a large series of children with newly diagnosed LCPD, hypothesizing that variation in anatomy may support the concept of anatomic-specific containment. METHODS A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 at diagnosis. To assess anatomy before significant morphologic changes secondary to the disease itself, only patients in Waldenström stages IA/IB were included. Standard hip radiographic measurements including acetabular index, lateral center-edge angle, proximal femoral neck-shaft angle (NSA), articulotrochanteric quartiles, and extrusion index (EI) were made on printed anteroposterior pelvis radiographs. Age-specific percentiles were calculated for these measures using published norms. Significant outliers (≤10th/≥90th percentile) were reported where applicable. RESULTS A total of 168 patients with mean age at diagnosis of 8.0±1.3 years met inclusion criteria (81.5% male). Mean acetabular index for the entire cohort was 16.8±4.1 degrees; 58 hips (34.5%) were significantly dysplastic compared with normative data. Mean lateral center-edge angle was 15.9±5.2 degrees at diagnosis; 110 (65.5%) were ≤10th percentile indicating dysplasia (by this metric). Mean NSA overall was 136.5±7.0 degrees. Fifty-one (30.4%) and 20 (11.9%) hips were significantly varus (≤10th percentile) or valgus (≥90th percentile), respectively. Thirty-five hips (20.8%) were the third articulo-trochanteric quartiles or higher suggesting a higher-riding trochanter at baseline. Mean EI was 15.5%±9.0%, while 63 patients (37.5%) had an EI ≥20%. CONCLUSIONS The present study finds significant variation in baseline anatomy in children with early-stage LCPD, including a high prevalence of coexisting acetabular dysplasia as well as high/low NSAs. These variations suggest that the "one-surgery-fits-all" approach may lack specificity for a particular patient; a potentially wiser option may be an anatomic-specific containment operation (eg, acetabular-sided osteotomy for coexisting dysplasia, varus femoral osteotomy for valgus NSA). LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Joshua T Bram
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Rachel Y Goldstein
- Children's Orthopedic Center Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Jennifer C Laine
- Gillette Children's Specialty Healthcare, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Harry K W Kim
- Texas Scottish Rite Hospital for Children
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Wudbhav N Sankar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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Monuszko K, Malinzak M, Yang LZ, Niedzwiecki D, Fuchs H, Muh CR, Gingrich K, Lark R, Thompson EM. Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity. J Neurosurg Pediatr 2021; 27:375-381. [PMID: 33418531 DOI: 10.3171/2020.8.peds20428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with shunted hydrocephalus often accumulate high levels of radiation over their lifetimes during evaluation of hardware integrity. Current practice involves the use of a series of conventional radiographs for this purpose. Newer low-dose EOS radiography is currently used to evaluate scoliosis but has not been explored to evaluate shunt integrity on a large scale. The goal of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate shunt tubing. METHODS A retrospective chart review was performed on 57 patients who previously had both conventional radiographs and low-dose EOS images of their cerebral shunt tubing from 2000 to 2018. Patient demographics (age, sex, type of shunt tubing, primary diagnosis) were collected. Conventional radiographic images and low-dose EOS images were independently analyzed by a neurosurgeon and neuroradiologist in three categories: image quality, delineation of shunt, and distinction of shunt compared to adjacent anatomy. RESULTS All patients had shunted hydrocephalus due to spina bifida and Chiari type II malformation. Ratings of EOS and conventional radiographic images by both raters did not differ significantly in terms of image quality (rater 1, p = 0.499; rater 2, p = 0.578) or delineation of shunt (p = 0.107 and p = 0.256). Conventional radiographic images received significantly higher ratings than EOS on the ability to distinguish the shunt versus adjacent anatomy by rater 1 (p = 0.039), but not by rater 2 (p = 0.149). The overall score of the three categories combined was not significantly different between EOS and conventional radiography (rater 1, p = 0.818; rater 2, p = 0.186). In terms of cost, an EOS image was less costly than a conventional radiography shunt series ($236-$366 and $1300-$1547, respectively). The radiation dose was also lower for EOS images, with an effective dose of 0.086-0.140 mSv compared to approximately 1.6 mSv for a similar field of view with conventional radiography. CONCLUSIONS The image quality of low-dose EOS radiography does not significantly differ from conventional radiography for the evaluation of cerebral shunts. In addition, EOS affords a much lower radiation dose and a lower cost.
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Affiliation(s)
| | | | - Lexie Zidanyue Yang
- 3Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and
| | - Donna Niedzwiecki
- 3Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and
| | | | - Carrie R Muh
- 5Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
| | | | - Robert Lark
- 6Orthopedic Surgery, Duke University Medical Center
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Andras LM, Abousamra O. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2021; 103:287-294. [PMID: 33369978 DOI: 10.2106/jbjs.20.01953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Yang G, Jiang Y, Liu T, Zhao X, Chang X, Qiu Z. A Semi-automatic Diagnosis of Hip Dysplasia on X-Ray Films. Front Mol Biosci 2021; 7:613878. [PMID: 33392267 PMCID: PMC7773838 DOI: 10.3389/fmolb.2020.613878] [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] [Received: 10/04/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Diagnosis of hip joint plays an important role in early screening of hip diseases such as coxarthritis, heterotopic ossification, osteonecrosis of the femoral head, etc. Early detection of hip dysplasia on X-ray films may probably conduce to early treatment of patients, which can help to cure patients or relieve their pain as much as possible. There has been no method or tool for automatic diagnosis of hip dysplasia till now. Results: A semi-automatic method for diagnosis of hip dysplasia is proposed. Considering the complexity of medical imaging, the contour of acetabulum, femoral head, and the upper side of thigh-bone are manually marked. Feature points are extracted according to marked contours. Traditional knowledge-driven diagnostic criteria is abandoned. Instead, a data-driven diagnostic model for hip dysplasia is presented. Angles including CE, sharp, and Tonnis angle which are commonly measured in clinical diagnosis, are automatically obtained. Samples, each of which consists of these three angle values, are used for clustering according to their densities in a descending order. A three-dimensional normal distribution derived from the cluster is built and regarded as the parametric model for diagnosis of hip dysplasia. Experiments on 143 X-ray films including 286 samples (i.e., 143 left and 143 right hip joints) demonstrate the effectiveness of our method. According to the method, a computer-aided diagnosis tool is developed for the convenience of clinicians, which can be downloaded at http://www.bio-nefu.com/HIPindex/. The data used to support the findings of this study are available from the corresponding authors upon request. Conclusions: This data-driven method provides a more objective measurement of the angles. Besides, it provides a new criterion for diagnosis of hip dysplasia other than doctors' experience deriving from knowledge-driven clinical manual, which actually corresponds to very different way for clinical diagnosis of hip dysplasia.
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Affiliation(s)
- Guangyao Yang
- Department of Computer Science and Technology, College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Yaoxian Jiang
- Department of Radiology, Affiliated Zhongshan Hosptial of Dalian University, Dalian, China
| | - Tong Liu
- Department of Computer Science and Technology, College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Xudong Zhao
- Department of Computer Science and Technology, College of Information and Computer Engineering, Northeast Forestry University, Harbin, China
| | - Xiaodan Chang
- Department of Radiology, Affiliated Zhongshan Hosptial of Dalian University, Dalian, China
| | - Zhaowen Qiu
- Department of Computer Science and Technology, College of Information and Computer Engineering, Northeast Forestry University, Harbin, China.,Heilongjiang Tuomeng Technology Co. Ltd., Harbin, China
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