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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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Omidian H, Mfoafo K. Exploring the Potential of Nanotechnology in Pediatric Healthcare: Advances, Challenges, and Future Directions. Pharmaceutics 2023; 15:1583. [PMID: 37376032 DOI: 10.3390/pharmaceutics15061583] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
The utilization of nanotechnology has brought about notable advancements in the field of pediatric medicine, providing novel approaches for drug delivery, disease diagnosis, and tissue engineering. Nanotechnology involves the manipulation of materials at the nanoscale, resulting in improved drug effectiveness and decreased toxicity. Numerous nanosystems, including nanoparticles, nanocapsules, and nanotubes, have been explored for their therapeutic potential in addressing pediatric diseases such as HIV, leukemia, and neuroblastoma. Nanotechnology has also shown promise in enhancing disease diagnosis accuracy, drug availability, and overcoming the blood-brain barrier obstacle in treating medulloblastoma. It is important to acknowledge that while nanotechnology offers significant opportunities, there are inherent risks and limitations associated with the use of nanoparticles. This review provides a comprehensive summary of the existing literature on nanotechnology in pediatric medicine, highlighting its potential to revolutionize pediatric healthcare while also recognizing the challenges and limitations that need to be addressed.
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Affiliation(s)
- Hossein Omidian
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
| | - Kwadwo Mfoafo
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA
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Siddiqui AA, Andras LM, Obana KK, Murgai R, Illingworth KD, Tolo VT, Mariscal M, Ponrartana S, Skaggs DL. Using a dedicated spine radiology technologist is associated with reduced fluoroscopy time, radiation dose, and surgical time in pediatric spinal deformity surgery. Spine Deform 2021; 9:85-89. [PMID: 32780303 DOI: 10.1007/s43390-020-00183-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Retrospective comparative study OBJECTIVES: The goal of this study was to investigate fluoroscopy time and radiation exposure during pediatric spine surgery using a dedicated radiology technologist with extensive experience in spine operating rooms. Repetitive use of intraoperative fluoroscopy during posterior spinal fusion (PSF) exposes the patient, surgeon, and staff to radiation. METHODS Retrospective review was conducted on patients with posterior spinal fusion (PSF) of ≥ 7 levels for adolescent idiopathic scoliosis (AIS) at a pediatric hospital from 2015 to 2019. Cases covered by the dedicated radiology technologist (dedicated group) were compared to all other cases (non-dedicated group). Surgical and radiologic variables were compared between groups. RESULTS 230 patients were included. 112/230 (49%) were in the dedicated group and 118/230 (51%) were in the non-dedicated group. Total fluoroscopy time was significantly reduced in cases with the dedicated technologist (46 s) compared to those without (69 s) (p = 0.001). Radiation dose area product (DAP) and air kerma (AK) were reduced by 43% (p < 0.001) and 42% (p < 0.001) in the dedicated group, respectively. The dedicated group also had reduced total surgical time (4.1 vs. 3.5 h; p < 0.001) and estimated blood loss (447 vs. 378 cc (; p = 0.02). Multivariate regression revealed that using a dedicated radiology technologist was independently associated with decreased fluoroscopy time (p = 0.001), DAP (p < 0.001), AK (p < 0.001), surgical time (p < 0.001), and EBL (p = 0.02). CONCLUSIONS In AIS patients undergoing PSF, using a dedicated radiology technologist was independently associated with significant reductions in fluoroscopy time, radiation exposure, surgical time, and EBL. This adds to the growing body of research demonstrating that the experience level of the team-not just that of the surgeon-is necessary for optimal outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali A Siddiqui
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of FL College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Lindsay M Andras
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Kyle K Obana
- Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of Hawaii, Honolulu, HI, USA
| | - Rajan Murgai
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of Miami, Miami, FL, USA
| | - Kenneth D Illingworth
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Vernon T Tolo
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Michael Mariscal
- Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Skorn Ponrartana
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - David L Skaggs
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA. .,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
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Garg B, Mehta N, Bansal T, Malhotra R. EOS® imaging: Concept and current applications in spinal disorders. J Clin Orthop Trauma 2020; 11:786-793. [PMID: 32879565 PMCID: PMC7452333 DOI: 10.1016/j.jcot.2020.06.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
EOS® imaging is a proprietary imaging technology that was launched in 2007. Based on a gaseous particle detector with a multi-wire proportional chamber, it offers several advantages over other imaging modalities: low dose of radiation, ability to create 3D reconstructions, ability to conduct whole body imaging, high reproducibility in measuring various parameters of alignment and faster imaging time. EOS® imaging is slowly gaining widespread acceptance as its applications in various disorders continue to evolve. It has been found to be particularly useful and has opened up new avenues of research in the field of spinal deformities. This narrative review seeks to provide an overview of the proprietary technology behind EOS® imaging, compare it to existing imaging modalities, summarize its current applications in various spinal disorders and outline its limitations.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Tungish Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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