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Tomaiuolo R, Banfi G, Messina C, Albano D, Gitto S, Sconfienza LM. Health technology assessment in musculoskeletal radiology: the case study of EOSedge™. LA RADIOLOGIA MEDICA 2024; 129:1076-1085. [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Health technology assessment (HTA) is a systematic process used to evaluate the properties and effects of healthcare technologies within their intended use context. This paper describes the adoption of HTA process to assess the adoption of the EOSedge™ system in clinical practice. METHODS The EOSedge™ system is a digital radiography system that delivers whole-body, high-quality 2D/3D biplanar images covering the complete set of musculoskeletal and orthopedic exams. Full HTA model was chosen using the EUnetHTA Core Model® version 3.0. The HTA Core Model organizes the information into nine domains. Information was researched and obtained by consulting the manufacturers' user manuals, scientific literature, and institutional sites for regulatory aspects. RESULTS All nine domains of the EUnetHTA Core Model® helped conduct the HTA of the EOSedge, including (1) description and technical characteristics of the technology; (2) health problem and current clinical practice; (3) safety; (4) clinical effectiveness; (5) organizational aspects; (6) economic evaluation; (7) impact on the patient; (8) ethical aspects; and (9) legal aspects. CONCLUSIONS EOS technologies may be a viable alternative to conventional radiographs. EOSedge has the same intended use and similar indications for use, technological characteristics, and operation principles as the EOS System and provides significant dose reduction factors for whole spine imaging compared to the EOS System without compromising image quality. Regarding the impact of EOS imaging on patient outcomes, most studies aim to establish technical ability without evaluating their ability to improve patient outcomes; thus, more studies on this aspect are warranted.
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Affiliation(s)
- Rossella Tomaiuolo
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Narahashi É, Guimarães JB, Filho AGO, Nico MAC, Silva FD. Measurement of tibial slope using biplanar stereoradiography (EOS®). Skeletal Radiol 2024; 53:1091-1101. [PMID: 38051424 DOI: 10.1007/s00256-023-04528-9] [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: 10/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. METHODS This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. RESULTS The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738-0.883 and 0.870-0.975). CONCLUSIONS Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.
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Affiliation(s)
- Érica Narahashi
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Flávio Duarte Silva
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
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Farivar D, Skaggs DL, Gabriel K, Illingworth KD. Breast Cancer Incidence, Mortality, and Cost in Adolescent Idiopathic Scoliosis Patients and the Role of Low Dose Biplanar Radiography. J Am Acad Orthop Surg 2023; 31:e633-e637. [PMID: 37432975 DOI: 10.5435/jaaos-d-23-00062] [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] [Received: 01/21/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Patients with adolescent idiopathic scoliosis (AIS) are susceptible to high doses of radiation from radiographs. The purpose of this study was to examine the future cost of radiation-induced breast cancer in patients with AIS and its potential financial and mortality impact. METHODS A literature review identified articles relating radiation exposure in patients with AIS to increased risk for cancer. Based on population statistics and breast cancer treatment costs in the year 2020, the financial impact of radiation-induced breast cancer and the estimated number of additional deaths per year due to breast cancer for patients with AIS were calculated. RESULTS The US female population in 1970 was 205.1 million. Based on a prevalence of 3.0%, an estimated 3.1 million patients had AIS in 1970. With an incidence of breast cancer in the general population of 128.3/100,000 and a standardized incidence ratio of 1.82-2.4 for breast cancer in patients with scoliosis, there will be a 3,282 to 5,603 patient increase in radiation-induced breast cancer in patients with scoliosis over the general population. With a projected base cost of $34,979 per patient for the first year of breast cancer diagnosis in 2020, the cost of radiation-induced breast cancer will be 114.8 to 196.0 million dollars per year. Using a standardized mortality ratio of 1.68 for scoliosis radiation-induced breast cancer, there will be an expected increase in deaths of 420 patients due to breast cancer presumably secondary to radiation exposure in the evaluation and treatment of AIS. CONCLUSION The estimated radiation-induced breast cancer financial impact in 2020 will be between 114.8 and 196.0 million dollars per year, with an increase in deaths of 420 patients per year. Low-dose imaging systems reduce radiation exposure by up to 45 times while maintaining sufficient image quality. New low-dose radiography should be used whenever possible with patients with AIS. LEVEL OF EVIDENCE Level 5.
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Affiliation(s)
- Daniel Farivar
- From the Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA (Farivar, Skaggs, and Illingworth), and the Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL (Gabriel)
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Piai A, Loria A, Tiberio P, Magnino S, Campoleoni M, Sconfienza LM, del Vecchio A. ASSESSMENT OF PCXMC MONTE CARLO SIMULATIONS IN SLOT-SCANNING-BASED EXAMINATIONS: COMPARISON WITH IN-PHANTOM THERMOLUMINESCENT DOSIMETRY. RADIATION PROTECTION DOSIMETRY 2023; 199:ncac273-234. [PMID: 36583519 PMCID: PMC9985171 DOI: 10.1093/rpd/ncac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/07/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Slot-scanning technology is nowadays a valid solution for the follow-up of chronic musculoskeletal disorders on children and adolescent patients, but there is no commercial software designed for simulating this X-ray beam geometry. PC Program for X-ray Monte Carlo (PCXMC) is a widespread Monte Carlo software developed for dose computation in projection radiography. In this study, experimental measurements were performed to evaluate its applicability in examinations with a slit-beam device. Physical phantoms corresponding to an adult and a 5-y-old child with calibrated thermoluminescent dosemeters were used for experiments. Different simulation approaches were investigated. Differences between measured and calculated organ doses ranged from -95 to 67% and were statistically significant for almost all organs. For both patients, PCXMC underestimated the effective dose of about 25%. This study suggests that PCXMC is not suited for organ dose evaluation in examinations with slot-scanning devices. It is still a useful tool for effective dose estimation when a proper correction factor is applied.
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Affiliation(s)
| | - A Loria
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - P Tiberio
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - S Magnino
- Postgraduate School of Medical Physics, Università degli Studi di Milano, 20133 Milan, Italy
| | - M Campoleoni
- Medical Physics Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - L M Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20123 Milan, Italy
| | - A del Vecchio
- Medical Physics Department, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Boissonnat G, Morichau-Beauchant P, Reshef A, Villa C, Désauté P, Simon AC. Performance of automatic exposure control on dose and image quality: comparison between slot-scanning and flat-panel digital radiography systems. Med Phys 2023; 50:1162-1184. [PMID: 36069636 DOI: 10.1002/mp.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND EOSedge™* (EOS Imaging, Paris, France) is an X-ray imaging system using automatic exposure control (AEC) with tube current modulation, in order to optimize dose deposition in patients. PURPOSE This study aims at characterizing EOSedge organ dose deposition in comparison to a digital radiography (DR) system and the previous EOS system (EOS-1st generation), in relation to their respective image quality levels. METHOD Organ doses were measured in an anthropomorphic female adult phantom and a 5-year-old pediatric phantom using optically stimulated luminescence (OSL) dosimeters, which were carefully calibrated within the studied energy range. Organ doses were recorded on the EOSedge and the Fuji Visionary DRF (Fujifilm Medical Systems U.S.A., Inc, Lexington, MA). The resulting effective doses were compared to the EOS-1st-generation values present in the literature. Image quality assessment was carried out on end-user images. Quantitative image quality metrics were computed for all tested modalities on a quality assurance phantom. Qualitative assessment of EOSedge image quality was based on anthropomorphic phantom acquisitions against the EOS-1st-generation system, and on clinical images against the tested DR system. RESULTS For a full-spine exam, and on the female adult phantom (respectively, the pediatric phantom), an effective dose of 92 μSv (respectively, 32 μSv) was obtained on EOSedge, and 572 μSv (respectively, 179 μSv) on the DR system; these values were compared to effective dose values of 290 μSv (respectively, 200 μSv) from the literature on EOS-1st generation, leading to an effective dose reduction factor of 6 with respect to the DR system, and of 3-6 with respect to EOS-1st generation. EOSedge provides the best compromise between contrast-to-noise ratio (CNR) and dose, with more consistent CNR values than the other tested modalities, in a range of attenuation from 10 to 40 cm of poly(methyl methacrylate) (PMMA). Within this range, EOSedge is also comparable to DR for 10 and 20 cm of PMMA, and better than DR for 30 and 40 cm of PMMA, both in terms of spatial resolution and low-contrast detection. The anatomical landmarks of interest in the follow-up of spinal deformities can be detected in all tested modalities. CONCLUSION Results showed that EOSedge provides significant dose reduction factors for full spine imaging in both adults and children compared to the other tested modalities, without compromising image quality. We believe that this work could help raise awareness on the capabilities of modern X-ray systems, when equipped with appropriate AEC strategies, to perform ultra-low-dose, long-axis images.
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Skaggs KF, Bainton NM, Boby AZ, Rymond CC, Fields MW, Roye BD, Vitale MG. Reliability of Preoperative Supine Versus Bending Radiographs in Estimating the Structural Nature of Curves in EOS. J Pediatr Orthop 2023; 43:70-75. [PMID: 36607916 DOI: 10.1097/bpo.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The study sought to evaluate the utility of a single supine radiograph in determining curve flexibility in early-onset scoliosis (EOS) patients. METHODS EOS patients with upright (standing/seated), supine, and side-bending radiographs who underwent spinal deformity surgery were identified. Coronal parameters included: proximal thoracic (PT) curve, main thoracic (MT) curve, and thoracolumbar/lumbar (TL/L) curve. Each radiograph was measured twice by 2 different raters. Correlation coefficients were utilized to investigate associations between the different radiographs. Interrater Correlation Coefficient (ICC) assessed intrarater and interrater reliability. RESULTS Thirty-seven EOS patients were identified (age at diagnosis: 7.0±2.9 y, preoperative age: 13.0±2.9 y; 73% female; etiologies: 54% idiopathic, 30% syndromic, and 16% neuromuscular). Supine PT and MT curve measurements were highly associated with corresponding side-bending measurements (PT: r=0.75, P<0.001; MT: r=0.80, P<0.001), and TL/L curves were very highly associated (TL/L: r=0.92, P<0.001). The mean absolute differences between supine and side-bending measurements were PT: 11.3±7.8 degrees, MT: 14.8±8.3 degrees, and TL/L: 16.2±7.6 degrees, where the side-bending was on average smaller than the supine measurement. The intrarater reliabilities were excellent, with an ICC ranging from 0.93 to 0.96 for side-bending films and 0.94 to 0.97 for supine films. The interrater reliability was excellent with ICC value of 0.88 for side-bending films and 0.93 for supine films. CONCLUSIONS A single, preoperative supine radiograph was highly predictive of side-bending radiographs in patients with EOS. Supine curves measured an average of 15 degrees larger than bending curves in the MT and TL/L region. A single supine film may eliminate the need for effort-related, dual side-bending radiographs. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
- Kira F Skaggs
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Nicole M Bainton
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Afrain Z Boby
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Christina C Rymond
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Michael W Fields
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Chua CXK, Tan SHS, Lim AKS, Hui JH. Accuracy of biplanar linear radiography versus conventional radiographs when used for lower limb and implant measurements. Arch Orthop Trauma Surg 2022; 142:735-745. [PMID: 33386975 DOI: 10.1007/s00402-020-03700-3] [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: 07/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The current standard of care for measuring lower extremity length and angular discrepancies is using a full-length standing anteroposterior radiograph. However, there has been increasing interest to use biplanar linear EOS imaging as an alternative. This study aims to compare lower extremity length and implant measurements between biplanar linear and conventional radiographs. MATERIALS AND METHODS In this 5-year retrospective study, all patients who had a standing full-length anteroposterior and biplanar linear radiographs (EOS®) that include the lower extremities done within one year of each other were included. Patients who underwent surgery in between the imaging, underwent surgeries that could result in graduated length or angulated corrections and inadequate exposure of the lower extremity were excluded. Four radiographic segments were measured to assess lower limb alignment and length measurements. Height and width measurements of implants were performed for patients who had implants in both imaging. RESULTS When comparing imaging and actual implant dimensions, biplanar linear radiographs were accurate in measuring actual implant height (median difference = - 0.14 cm, p = 0.66), and width (median difference = - 0.13 cm, p = 0.71). However, conventional radiographs were inaccurate in measuring actual implant height (median difference = 0.19 cm, p = 0.01) and width (median difference = 0.61 cm, p < 0.01). When comparing conventional and biplanar linear radiographs, there was statistically significant difference in all measurements. This includes anatomical femoral length (median difference = 3.53 cm, p < 0.01), mechanical femoral length (median difference = 3.89 cm, p < 0.01), anatomical tibial length (median difference = 2.34 cm, p < 0.01) and mechanical tibial length (median difference = 2.20 cm, p < 0.01). CONCLUSION First, there is a significant difference in the lower extremity length when comparing conventional and biplanar linear radiographs. Second, biplanar linear radiographs are found to be accurate while conventional radiographs are not as accurate in implant measurements of length and width in the lower extremity.
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Affiliation(s)
- Chen Xi Kasia Chua
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore.
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
| | - James Hoipo Hui
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
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Kelly C, Delakis I. Technical evaluation of a clinical, bi-planar, digital and upright X-ray imaging unit. J Med Radiat Sci 2021; 68:475-481. [PMID: 34096199 PMCID: PMC8655884 DOI: 10.1002/jmrs.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/04/2021] [Accepted: 05/22/2021] [Indexed: 11/07/2022] Open
Abstract
We describe the technical evaluation of the commercially available, clinical, bi-planar, low dose, digital X-ray system (EOS System, EOS imaging, France). The unit is used for upright, weight-bearing musculoskeletal pathologies, in particular, in the spine and lower limbs. The evaluation incorporated tests on the X-ray generator performance, radiation/imaging field alignment, dose area product accuracy and image quality. The assessment methodology was based on objective parameters and required equipment readily available for technical evaluation of other radiological equipment. Results demonstrated that the system performs well within acceptable performance criteria with regard to X-ray generator performance, radiation/imaging field alignment and dose area product accuracy. In addition, results from the image-quality assessment were aligned with previously published work. The work presented in this article can be used for the technical evaluation of the EOS System at other clinical sites.
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Affiliation(s)
- Charlotte Kelly
- Radiology DepartmentSidra Medical and Research CenterDohaQatar
| | - Ioannis Delakis
- Radiology DepartmentSidra Medical and Research CenterDohaQatar
- Radiology DepartmentWeill Cornell Medical CollegeNYUSA
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Walter C, Schaefer JF, Tsiflikas I. Reduction of radiation exposure in scoliosis monitoring using flat detector and pulsed fluoroscopy technology. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A new flat detector and pulsed fluoroscopy technology is available to further reduce radiation exposure in radiological monitoring during scoliosis treatment in children and adolescents. The aim of this study is to compare different settings of the system (opening area(OA) and image quality settings (IQS)) in order to find the optimal parameters with high image quality and the lowest possible radiation exposure. Therefore, we examined four cadaver spines (T1 to sacrum) with the flat detector technique using digital pulsed fluoroscopy and simulated the abdominal soft tissues. The images were merged and evaluated by three different investigators using an established scoring system. For comparison, we used digital radiography images of the cadaver spines. The values for the DAP increased from the small OA (33% ; 0.56 µGy·m²) to the maximum OA (100% ; 0.82 µGy·m²) by 45% (p = .003) and from the low image quality setting (0.57 µGy·m²) to the high setting (0.84 µGy·m²) by 48% (p = .028). Despite the low DAP, the setting 33% OA achieved the best point values for image quality, therefore this setting is clearly preferred. Using a digital fluoroscopy system allows a significant reduction of radiation exposure by a factor of 7.5 (3.88µGy·m² to 0.5µGy·m²) compared to slot- scanning x-ray (EOS). Due to this success, the flat detector and pulsed fluoroscopy technology can be an alternative to established methods such as X-ray and EOS in clinical use.
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Pang H, Wong YS, Yip BHK, Hung ALH, Chu WCW, Lai KKL, Zheng YP, Chung TWH, Sharma G, Cheng JCY, Lam TP. Using Ultrasound to Screen for Scoliosis to Reduce Unnecessary Radiographic Radiation: A Prospective Diagnostic Accuracy Study on 442 Schoolchildren. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2598-2607. [PMID: 34210559 DOI: 10.1016/j.ultrasmedbio.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Scoliosis screening is important for timely initiation of brace treatment to mitigate curve progression in skeletally immature children and adolescents. School scoliosis screening programs in Hong Kong follow the protocol of referring children screened positive with a scoliometer and Moiré topography for confirmatory standard radiography. Despite being highly sensitive (88%) in detecting those who require specialist referral, the screening program was found to have a false-positive rate >50%, which could lead to unnecessary X-ray radiation. Radiation-free ultrasound has been reported to be valid and reliable for quantitative assessment of curve severity in scoliosis patients. The aim of this prospective diagnostic accuracy study was to determine the accuracy of ultrasound in determining the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography. Our study recruited 442 schoolchildren with a mean Cobb angle of 14.0 ± 6.6°. The sensitivity and specificity of ultrasound in predicting the correct referral status, confirmed by X-ray, were 92.3% and 51.6%, with positive and negative predictive values of 29.0% and 96.9%, respectively. Receiver operating characteristic curve analysis revealed area under the curve values of 0.735 for ultrasound alone and 0.832 for ultrasound in combination with measurement of angle of trunk rotation. The finding supports the accuracy of using ultrasound to determine referral status, which could result in a >50% reduction of unnecessary radiation for children undergoing scoliosis screening.
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Affiliation(s)
- Henry Pang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Yi-Shun Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Alec Lik-Hang Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | | | - Geeta Sharma
- Student Health Service, Department of Health, Hong Kong SAR
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR; S. H. Ho Scoliosis Research Laboratory, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Hong Kong SAR.
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Pedersen PH, Petersen AG, Ostgaard SE, Tvedebrink T, Eiskjær SP. HOW MANY DOSEMETERS ARE NEEDED FOR CORRECT MEAN ORGAN DOSE ASSESSMENT WHEN PERFOMING PHANTOM DOSIMETRY? A PHANTOM STUDY EVALUATING LIVER ORGAN DOSE AND INVESTIGATING TLD NUMBERS AND WAYS OF DOSEMETER PLACEMENT. RADIATION PROTECTION DOSIMETRY 2020; 189:475-488. [PMID: 32424427 DOI: 10.1093/rpd/ncaa062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/28/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
This study evaluated repeated mean organ dose measurements of the liver by phantom dosimetry and statistical modelling in order to find a way to reduce the number of dosemeters needed for precise organ dose measurements. Thermoluminescent dosemeters were used in an adult female phantom exposed to a biplanar x-ray source at three different axial phantom rotations. Generalised mixed linear effect modelling was used for statistical analysis. A subgroup of five to six organ-specific locations out of 28 yielded mean liver organ doses within 95% confidence intervals of measurements based on all 28 liver-specific dosemeter locations. No statistical difference of mean liver dose was observed with rotation of the phantom either 10° clockwise or counter-clockwise as opposed to the coronal plane. Phantom dosimetry handling time during organ dose measurements can be markedly reduced, in this case the liver, by 79% (22/28), while still providing precise mean organ dose measurements.
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Affiliation(s)
- Peter H Pedersen
- Department of Orthopaedic Surgery, Aalborg Universitetshospital, Syd, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Asger G Petersen
- Region Nordjylland, Røntgenfysik, Merkurvej 13, 9700 Brønderslev, Denmark
| | - Svend E Ostgaard
- Department of Orthopaedic Surgery, Aalborg Universitetshospital, Syd, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Torben Tvedebrink
- Department of Mathematical Sciences, Aalborg University, Skjernvej 4A, 9220 Aalborg Øst, Denmark
| | - Søren P Eiskjær
- Department of Orthopaedic Surgery, Aalborg Universitetshospital, Syd, Hobrovej 18-22, 9000 Aalborg, Denmark
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Berg BI, Laville A, Courvoisier DS, Rouch P, Schouman T. Experiences with a new biplanar low-dose X-ray device for imaging the facial skeleton: A feasibility study. PLoS One 2020; 15:e0235032. [PMID: 32614831 PMCID: PMC7331994 DOI: 10.1371/journal.pone.0235032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to evaluate the feasibility of a new biplanar low-dose X-ray device for facial skeletal imaging. Methods We evaluated 48 biplanar radiographs from 12 patients (posteroanterior/lateral), originally taken for a scoliosis examination with a biplanar low-dose X-ray device. For this study, the images were further evaluated for the perceptibility of 38 facial skeleton landmarks. To determine the reliability and reproducibility of perceptibility, two independent observers determined the landmarks twice, during a time interval of at least two weeks. Results Both interoperator and intraoperator reliability were excellent for all landmarks [intraclass correlation coefficient (ICC) > 0.92]. Conclusions The biplanar low-dose X-ray device demonstrated good feasibility for precisely assessing the anatomical landmarks of the facial skeleton. Given its excellent precision, the biplanar low-dose X-ray device data sets should be forwarded from the treating orthopedic surgeon or neurosurgeon to the orthodontist or dentist for further assessment in their field.
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Affiliation(s)
- Britt-Isabelle Berg
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel and University Basel, Basel, Switzerland
- * E-mail:
| | - Aurélien Laville
- Laboratoire de Biomécanique, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Delphine S. Courvoisier
- CRC & Division of Clinical Epidemiology, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Rouch
- Laboratoire de Biomécanique, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Thomas Schouman
- Department of Maxillofacial Surgery, APHP—Groupe Hospitalier Pitie-Salpetriere, Universite Paris 6—UPMC, Paris, France
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PRATALI RAPHAELDEREZENDE, DAHER MURILOTAVARES, MEVES ROBERT. BIPLANAR IMAGING WITH TRIDIMENSIONAL CAPABILITIES: APPLICABILITY OF THIS NEW EXAMINATION TO SPINAL DEFORMITIES. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201901222631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.
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Affiliation(s)
| | | | - ROBERT MEVES
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Brazil
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Shih YC, Chau MM, Arendt EA, Novacheck TF. Measuring Lower Extremity Rotational Alignment: A Review of Methods and Case Studies of Clinical Applications. J Bone Joint Surg Am 2020; 102:343-356. [PMID: 31743239 DOI: 10.2106/jbjs.18.01115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yushane C Shih
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael M Chau
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth A Arendt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tom F Novacheck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.,Gillette Children's Specialty Healthcare, St. Paul, Minnesota
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Abdi AJ, Mussmann B, Mackenzie A, Klaerke B, Andersen PE. COMPARISON OF RADIATION EXPOSURE TO THE PATIENT AND CONTRAST DETAIL RESOLUTIONS ACROSS LOW DOSE 2D/3D SLOT SCANNER AND TWO CONVENTIONAL DIGITAL RADIOGRAPHY X-RAY IMAGING SYSTEMS. RADIATION PROTECTION DOSIMETRY 2019; 185:252-265. [PMID: 30809672 DOI: 10.1093/rpd/ncz006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess and compare the radiation dose and image quality of the low dose 2D/3D EOS slot scanner (LDSS) to conventional digital radiography (DR) X-ray imaging systems for chest and knee examination protocols. METHODS AND MATERIALS The effective doses (ED) to the patient in the chest and knee clinical examination protocols for LDSS and DR X-ray imaging systems were determined using the dose area product and PCXMC Monte Carlo simulation software. The CDRAD phantom was imaged with 19 cm, and 13 cm thick Polymethyl Methacrylate (PMMA) blocks to simulate the chest and knees respectively of a patient of average adult size. The contrast detail resolution was calculated using image analysis software. RESULTS The EDs for the LDSS default setting were up to 69% and 51% lower than for the DR systems for the chest (speed 4) and knee (speed 6) protocols, respectively, while for the increased dose level setting then the EDs were up to 42% and 35% lower than for the DR systems for the chest (speed 6) and knee (speed 8) protocols respectively. At the default setting, the contrast detail was lowest for the default setting of the 2D/3D low dose slot scanner (LDSS) for both chest and knee examinations, but at the highest dose levels then the threshold were equal or higher than the contrast resolution of DR imaging systems. CONCLUSION The LDSS has the potential to be used for clinical diagnosis of chest and knee examinations using the higher dose level. For speed 6 in chest protocol and speed 8 in knee protocol, the measured contrast detail resolution was comparable with the DR systems but at a lower effective dose.
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Affiliation(s)
- Ahmed Jibril Abdi
- Region of Southern Denmark, Clinical Engineering Department, Area of Diagnostic Radiology, B. Winsløws Vej 4, Indgang 34, Odense C, Denmark
| | - Bo Mussmann
- Department of Radiology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Alistair Mackenzie
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Benedikte Klaerke
- Region of Southern Denmark, Clinical Engineering Department, Area of Diagnostic Radiology, B. Winsløws Vej 4, Indgang 34, Odense C, Denmark
| | - Poul Erik Andersen
- Department of Radiology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study. Clin Spine Surg 2019; 32:E340-E345. [PMID: 31162186 DOI: 10.1097/bsd.0000000000000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN This was a prospective validation study with technical notes. OBJECTIVE This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the "nano-dose" protocol. SUMMARY OF BACKGROUND DATA Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced. METHODS An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction. RESULTS A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals. CONCLUSIONS We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
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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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18
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Vertebral strength prediction from Bi-Planar dual energy x-ray absorptiometry under anterior compressive force using a finite element model: An in vitro study. J Mech Behav Biomed Mater 2018; 87:190-196. [DOI: 10.1016/j.jmbbm.2018.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
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A reduced micro-dose protocol for 3D reconstruction of the spine in children with scoliosis: results of a phantom-based and clinically validated study using stereo-radiography. Eur Radiol 2018; 29:1874-1881. [DOI: 10.1007/s00330-018-5749-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
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Aubry S, Padoin P, Petegnief Y, Vidal C, Riethmuller D, Delabrousse E. Can three-dimensional pelvimetry using low-dose stereoradiography replace low-dose CT pelvimetry? Diagn Interv Imaging 2018; 99:569-576. [PMID: 29567122 DOI: 10.1016/j.diii.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) pelvimetry. MATERIALS AND METHODS Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26μGy) than CT (1140±220μGy, P<0.0001). The effective maternal dose was 3.1 times lower using SRI (97±21μSv) than CT (310±60μSv; P<0.0001). CONCLUSION Pelvic inlet measurements using SRI are reliable. Compared to CT pelvimetry, SRI leads to a significant decrease in fetal and maternal radiation doses. These findings should prompt physicians to use SRI as the first-line approach for pelvimetry.
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Affiliation(s)
- S Aubry
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France; Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France.
| | - P Padoin
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France
| | - Y Petegnief
- Department of Nuclear Medicine, CHRU Besançon, 25000 Besançon, France
| | - C Vidal
- Clinical Investigation Center, Inserm CIT808, CHRU Besançon, 25000 Besançon, France
| | - D Riethmuller
- Department of Obstetrics and Gynecology, CHRU Besançon, 25000 Besançon, France
| | - E Delabrousse
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France; Department of Abdominal Imaging, CHRU Besançon, 25000 Besançon, France
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Ng SY, Bettany-Saltikov J. Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis. Open Orthop J 2017; 11:1500-1520. [PMID: 29399226 PMCID: PMC5759132 DOI: 10.2174/1874325001711011500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis. The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.
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Affiliation(s)
- Shu-Yan Ng
- Wanchai Chiropractic Clinic, 11/fl China Hong Kong Tower, 8 Hennessy Road, Wanchai, Hong Kong
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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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Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E. Non-radiographic methods of measuring global sagittal balance: a systematic review. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:30. [PMID: 29026895 PMCID: PMC5625601 DOI: 10.1186/s13013-017-0135-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/11/2017] [Indexed: 01/21/2023]
Abstract
Background Global sagittal balance, describing the vertical alignment of the spine, is an important factor in the non-operative and operative management of back pain. However, the typical gold standard method of assessment, radiography, requires exposure to radiation and increased cost, making it unsuitable for repeated use. Non-radiologic methods of assessment are available, but their reliability and validity in the current literature have not been systematically assessed. Therefore, the aim of this systematic review was to synthesise and evaluate the reliability and validity of non-radiographic methods of assessing global sagittal balance. Methods Five electronic databases were searched and methodology evaluated by two independent reviewers using the13-item, reliability and validity, Brink and Louw critical appraisal tool. Results Fourteen articles describing six methodologies were identified from 3940 records. The six non-radiographic methodologies were biophotogrammetry, plumbline, surface topography, infra-red motion analysis, spinal mouse and ultrasound. Construct validity was evaluated for surface topography (R = 0.49 and R = 0.68, p < 0.001), infra-red motion-analysis (ICC = 0.81) and plumbline testing (ICC = 0.83). Reliability ranged from moderate (ICC = 0.67) for spinal mouse to very high for surface topography (Cronbach α = 0.985). Measures of agreement ranged from 0.9 mm (plumbline) to 22.94 mm (infra-red motion-analysis). Variability in study populations, reporting parameters and statistics prevented a meta-analysis. Conclusions The reliability and validity of the non-radiographic methods of measuring global sagittal balance was reported within 14 identified articles. Based on this limited evidence, non-radiographic methods appear to have moderate to very high reliability and limited to three methodologies, moderate to high validity. The overall quality and methodological approaches of the included articles were highly variable. Further research should focus on the validity of non-radiographic methods with a greater adherence to reporting actual and clinically relevant measures of agreement.
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Affiliation(s)
- Larry Cohen
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Sarah Kobayashi
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Milena Simic
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Sarah Dennis
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Kathryn Refshauge
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Evangelos Pappas
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
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Thompson W, Thakar C, Rolton DJ, Wilson-MacDonald J, Nnadi C. The use of magnetically-controlled growing rods to treat children with early-onset scoliosis: early radiological results in 19 children. Bone Joint J 2017; 98-B:1240-7. [PMID: 27587527 DOI: 10.1302/0301-620x.98b9.37545] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/06/2016] [Indexed: 12/16/2022]
Abstract
AIMS We undertook a prospective non-randomised radiological study to evaluate the preliminary results of using magnetically-controlled growing rods (MAGEC System, Ellipse technology) to treat children with early-onset scoliosis. PATIENTS AND METHODS Between January 2011 and January 2015, 19 children were treated with magnetically-controlled growing rods (MCGRs) and underwent distraction at three-monthly intervals. The mean age of our cohort was 9.1 years (4 to 14) and the mean follow-up 22.4 months (5.1 to 35.2). Of the 19 children, eight underwent conversion from traditional growing rods. Whole spine radiographs were carried out pre- and post-operatively: image intensification was used during each lengthening in the outpatient department. The measurements evaluated were Cobb angle, thoracic kyphosis, proximal junctional kyphosis and spinal growth from T1 to S1. RESULTS The mean pre-, post-operative and latest follow-up Cobb angles were 62° (37.4 to 95.8), 45.1° (16.6 to 96.2) and 43.2° (11.9 to 90.5), respectively (p < 0.05). The mean pre-, post-operative and latest follow-up T1-S1 lengths were 288.1 mm (223.2 to 351.7), 298.8 mm (251 to 355.7) and 331.1 mm (275 to 391.9), respectively (p < 0.05). In all, three patients developed proximal pull-out of their fixation and required revision surgery: there were no subsequent complications. There were no complications of outpatient distraction. CONCLUSIONS Our study shows that MCGRs provide stable correction of the deformity in early-onset scoliosis in both primary and revision procedures. They have the potential to reduce the need for multiple operations and thereby minimise the potential complications associated with traditional growing rod systems. Cite this article: Bone Joint J 2016;98-B:1240-47.
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Affiliation(s)
- W Thompson
- Spinal Unit, Bordeaux University Hospital, 33076, Bordeaux, France
| | - C Thakar
- Spinal Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK
| | - D J Rolton
- Auckland City Hospital, Park Road, Auckland, New, Zealand
| | - J Wilson-MacDonald
- Spinal Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK
| | - C Nnadi
- Spinal Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK
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Hui SCN, Pialasse JP, Wong JYH, Lam TP, Ng BKW, Cheng JCY, Chu WCW. Radiation dose of digital radiography (DR) versus micro-dose x-ray (EOS) on patients with adolescent idiopathic scoliosis: 2016 SOSORT- IRSSD "John Sevastic Award" Winner in Imaging Research. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:46. [PMID: 28035336 PMCID: PMC5198497 DOI: 10.1186/s13013-016-0106-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with adolescent idiopathic scoliosis (AIS) frequently receive x-ray imaging at diagnosis and subsequent follow monitoring. The ionizing radiation exposure has accumulated through their development stage and the effect of radiation to this young vulnerable group of patients is uncertain. To achieve the ALARA (as low as reasonably achievable) concept of radiation dose in medical imaging, a slot-scanning x-ray technique by the EOS system has been adopted and the radiation dose using micro-dose protocol was compared with the standard digital radiography on patients with AIS. METHODS Ninety-nine participants with AIS underwent micro-dose EOS and 33 underwent standard digital radiography (DR) for imaging of the whole spine. Entrance-skin dose was measured using thermoluminescent dosimeters (TLD) at three regions (i.e. dorsal sites at the level of sternal notch, nipple line, symphysis pubis). Effective dose and organ dose were calculated by simulation using PCXMC 2.0. Data from two x-ray systems were compared using independent-samples t-test and significance level at 0.05. All TLD measurements were conducted on PA projection only. Image quality was also assessed by two raters using Cobb angle measurement and a set of imaging parameters for optimization purposes. RESULTS Entrance-skin dose from micro-dose EOS system was 5.9-27.0 times lower at various regions compared with standard DR. The calculated effective dose was 2.6 ± 0.5 (μSv) and 67.5 ± 23.3 (μSv) from micro-dose and standard DR, respectively. The reduction in the micro-dose was approximately 26 times. Organ doses at thyroid, lung and gonad regions were significantly lower in micro-dose (p < 0.001). Data were further compared within the different gender groups. Females received significantly higher (p < 0.001) organ dose at ovaries compared to the testes in males. Patients with AIS received approximately 16-34 times lesser organ dose from micro-dose x-ray as compared with the standard DR. There was no significant difference in overall rating of imaging quality between EOS and DR. Micro-dose protocol provided enough quality to perform consistent measurement on Cobb angle. CONCLUSIONS Entrance-skin dose, effective dose and organ dose were significantly reduced in micro-dose x-ray. The effective dose of a single micro-dose x-ray (2.6 μSv) was less than a day of background radiation. As AIS patients require periodic x-ray follow up for surveillance of curve progression, clinical use of micro-dose x-ray system is beneficial for these young patients to reduce the intake of ionizing radiation.
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Affiliation(s)
- Steve C N Hui
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Jean-Philippe Pialasse
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China ; Department of Chiropractic, University of Quebec at Trois-Rivieres, Trois-Rivieres, Quebec Canada
| | - Judy Y H Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Tsz-Ping Lam
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Bobby K W Ng
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Jack C Y Cheng
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, SAR China
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Ben Abdennebi A, Aubry S, Ounalli L, Fayache MS, Delabrousse E, Petegnief Y. Comparative dose levels between CT-scanner and slot-scanning device (EOS system) in pregnant women pelvimetry. Phys Med 2016; 33:77-86. [PMID: 27993442 DOI: 10.1016/j.ejmp.2016.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/14/2016] [Accepted: 12/07/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To estimate fetal absorbed doses for pregnant women pelvimetry, a comparative study between EOS imaging system and low-dose spiral CT-scanner was carried out. For this purpose three different studies were investigated: in vivo, in vitro and Monte Carlo calculations. METHODS In vivo dosimetry was performed, using OSL NanoDot dosimeters, to determine the dose to the skin of twenty pregnant women. In vitro studies were established by using a cubic phantom of water, in order to estimate the out of field doses. In the latter study, OSLDs were placed at depths corresponding to the lowest, average and highest position of the uterus. Monte Carlo calculations of effective doses to high radio-sensitive organs were established, using PCXMC and CTExpo software suites for EOS imaging system and CT-scanner, respectively. RESULTS The EOS imaging system reduces radiation exposure 4 to 8 times compared to the CT-scanner. The entrance skin doses were 74% (p-values <0.01) higher with the CT-scanner than with the EOS system. In the out of field region, the measured doses of the EOS system were reduced by 80% (p-values <0.02). Monte Carlo calculations confirmed that effective doses to organs are less accentuated for EOS than for CT pelvimetry. CONCLUSIONS The EOS system is less irradiating than the CT exam. The out-of-field dose which is significant, is lower in the EOS than in the CT-scanner and could be reduced even further by optimizing the time used for image acquisition.
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Affiliation(s)
- A Ben Abdennebi
- Regional and University Hospital of Besançon, 25000 Besançon, France; Faculty of Mathematical, Physical and Natural Sciences of Tunis, 2092 El Manar, Tunis, Tunisia; Laboratory on Energy and Matter for Nuclear Sciences Development, LR16CNSTN02, Tunisia
| | - S Aubry
- Regional and University Hospital of Besançon, 25000 Besançon, France; Nanomedicine Lab Imagery and Therapeutics EA 4662, University of Franche-Comte, 25000 Besancon, France
| | - L Ounalli
- National Center for Nuclear Sciences and Technology, 2020 Ariana, Tunisia; Laboratory on Energy and Matter for Nuclear Sciences Development, LR16CNSTN02, Tunisia.
| | - M S Fayache
- Faculty of Mathematical, Physical and Natural Sciences of Tunis, 2092 El Manar, Tunis, Tunisia; Laboratory on Energy and Matter for Nuclear Sciences Development, LR16CNSTN02, Tunisia
| | - E Delabrousse
- Regional and University Hospital of Besançon, 25000 Besançon, France; Nanomedicine Lab Imagery and Therapeutics EA 4662, University of Franche-Comte, 25000 Besancon, France
| | - Y Petegnief
- Regional and University Hospital of Besançon, 25000 Besançon, France
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Decreased patient exposure to ionizing radiation during interventional rheumatology procedures after optimization of protection. Joint Bone Spine 2016; 84:335-339. [PMID: 27825575 DOI: 10.1016/j.jbspin.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To decrease radiation exposure of patients undergoing interventional rheumatology procedures, without adversely affecting quality of care. METHODS The radiation dose received, assessed by the dose-area product (DAP), was measured during 283 intraarticular injections performed under fluoroscopic guidance between May and July 2013. Then, three steps were taken to decrease patients' radiation exposure: a copper filter was added, the anti-scatter grid was removed, and exposure cell sensitivity was set at the highest value. DAP was measured during 158 intraarticular injections performed in 2014 with these measures in place. RESULTS Mean DAP before optimization was 175μGray·m2 during facet joint injections (n=4) and 43μGray·m2 during hip injections but was less than 20μGray·m2 for injections into the shoulders (15.7μGray·m2), ankles (7.7μGray·m2), wrists (3.7μGray·m2), and fingers (3.3μGray·m2). After optimization, DAP decreased markedly for all injection sites, by 52% (shoulders) to 87% (facet joints, 22.7μGray·m2). Decreases occurred at all three steps of the procedure, i.e., patient installation, injection, and last image hold. Exposure during facet joint injections varied from 84 (54.5-108.5) μGray·m2 when body mass index (BMI) was <25kg/m2 to 228.9 (161.3-340.4)μGray·m2 when BMI was>30kg/m2. CONCLUSION Simple technical changes translate into large decreases in patient radiation exposure during fluoroscopically-guided injections, particularly at the facet joints and in obese patients.
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Clavel AH, Monnin P, Létang JM, Verdun FR, Darbon A. CHARACTERISING THE EOS SLOT-SCANNING SYSTEM WITH THE EFFECTIVE DETECTIVE QUANTUM EFFICIENCY. RADIATION PROTECTION DOSIMETRY 2016; 169:319-324. [PMID: 26538617 DOI: 10.1093/rpd/ncv451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As opposed to the standard detective quantum efficiency (DQE), effective DQE (eDQE) is a figure of merit that allows comparing the performances of imaging systems in the presence of scatter rejection devices. The geometry of the EOS™ slot-scanning system is such that the detector is self-collimated and rejects scattered radiation. In this study, the EOS system was characterised using the eDQE in imaging conditions similar to those used in clinical practice: with phantoms of different widths placed in the X-ray beam, for various incident air kerma and tube voltages corresponding to the phantom thickness. Scatter fractions in EOS images were extremely low, around 2 % for all configurations. Maximum eDQE values spanned 9-14.8 % for a large range of air kerma at the detector plane from 0.01 to 1.34 µGy. These figures were obtained with non-optimised EOS setting but still over-performed most of the maximum eDQEs recently assessed for various computed radiology and digital radiology systems with antiscatter grids.
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Affiliation(s)
- A H Clavel
- Institute of Radiation Physics, CHUV, Rue du Grand-Pré 1, CH-1007 Lausanne, Switzerland Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, Lyon, France EOS imaging, 10 rue Mercœur, 75011 Paris, France
| | - P Monnin
- Institute of Radiation Physics, CHUV, Rue du Grand-Pré 1, CH-1007 Lausanne, Switzerland
| | - J M Létang
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Centre Léon Bérard, Lyon, France
| | - F R Verdun
- Institute of Radiation Physics, CHUV, Rue du Grand-Pré 1, CH-1007 Lausanne, Switzerland
| | - A Darbon
- EOS imaging, 10 rue Mercœur, 75011 Paris, France
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Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 2016; 10:1-14. [PMID: 26883033 PMCID: PMC4763151 DOI: 10.1007/s11832-016-0713-0] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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A flexible patch based approach for combined denoising and contrast enhancement of digital X-ray images. Med Image Anal 2016; 28:33-45. [DOI: 10.1016/j.media.2015.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/07/2015] [Accepted: 11/07/2015] [Indexed: 11/21/2022]
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Yvert M, Diallo A, Bessou P, Rehel JL, Lhomme E, Chateil JF. Radiography of scoliosis: Comparative dose levels and image quality between a dynamic flat-panel detector and a slot-scanning device (EOS system). Diagn Interv Imaging 2015; 96:1177-88. [PMID: 26282052 DOI: 10.1016/j.diii.2015.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare radiation dose and image quality between a slot-scanning system (SSS) and a dynamic flat-panel detector (DFD) in assessing scoliosis in children. METHODS An experimental study was first performed with a phantom to assess the quality of each device. The clinical part included a prospective observational dosimetric and qualitative comparative study with acquisition of whole-spine X-ray: SSS (31 children), DFD (26 children). Institutional review board approval and informed consent were obtained. Dosimetric statistical analysis was performed from dose area product (DAP) and entrance skin dose measured by thermo-luminescent dosimeters localized in the cervical, thoracic and sacral areas. Assessment of the diagnostic quality (phantom and clinical) was realized by independent evaluation by 3 observers, using statistical analysis of quality score and inter-observer reproducibility. RESULTS DAP was equivalent with the 2 systems. Entrance skin dose was significantly higher with DFD in thoracic and pelvic regions (P<0.05). Image quality scores of the SSS were significantly better than DFD for a majority of criteria, in both phantom and clinical evaluations. CONCLUSION For scoliosis evaluation, the SSS, compared to the DFD system, offers enhanced image quality while reducing the entrance skin dose in the most radiosensitive areas.
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Affiliation(s)
- M Yvert
- Service d'imagerie anté-natale, de l'enfant et de la femme, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Diallo
- Institute of Public Health, Epidemiology and Development (ISPED), Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - P Bessou
- Service d'imagerie anté-natale, de l'enfant et de la femme, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-L Rehel
- Institute for Radiological Protection and Nuclear Safety (IRSN), 31, avenue de la Division-Leclerc, 92260 Fontenay-aux-Roses, France
| | - E Lhomme
- Institute of Public Health, Epidemiology and Development (ISPED), Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - J-F Chateil
- Service d'imagerie anté-natale, de l'enfant et de la femme, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, Université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
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Luo TD, Stans AA, Schueler BA, Larson AN. Cumulative Radiation Exposure With EOS Imaging Compared With Standard Spine Radiographs. Spine Deform 2015; 3:144-150. [PMID: 27927305 DOI: 10.1016/j.jspd.2014.09.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/11/2014] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES This study sought to estimate the total radiation exposure to scoliosis patients during the entire treatment course using standard imaging techniques versus EOS posteroanterior (PA) and anteroposterior (AP) views. SUMMARY OF BACKGROUND DATA EOS is a slot-scanning X-ray system designed to reduce radiation exposure in orthopedic imaging. There are few independent studies comparing organ and total effective radiation dose from standard EOS PA, AP, and lateral imaging versus conventional projection radiographs for children with spinal deformity. METHODS A total of 42 skeletally immature idiopathic scoliosis patients were treated with bracing (21) or spinal fusion (21) and were followed to skeletal maturity. The number of scoliosis radiographs (PA and lateral) for each patient was recorded. A computerized dosing model was used to calculate estimated patient and organ doses for PA and lateral scoliosis X-rays taken with EOS or computed radiography with a filter (CR) or without a filter (CRF). Assuming that each X-ray taken delivered the same radiation as the phantom calculation, the authors estimated the total effective and organ dose that each adolescent would have received using EOS, CR, or CRF. Annual background radiation is 3 mSv. RESULTS Mean number of radiographs per patient was 20.9 (range, 8-43). Patients who underwent surgical treatment had a significantly greater number of X-rays than those who were braced (27.3 vs. 14.5; p < .001). Assuming all films were CR, the mean cumulative dose was estimated at 5.38 mSv. With standard EOS films, the mean cumulative estimated dose was 2.66 mSv, a decrease of 50.6%. An AP versus PA EOS radiograph resulted in an 8 times higher radiation dose to the breasts and 4 times higher dose to the thyroid. CONCLUSIONS The standard EOS imaging system moderately reduced the total radiation exposure to skeletally immature scoliosis patients. Over the entire treatment course, this represented 2.72 mSv mean reduction or 0.91 years of background radiation. Posteroanterior films significantly reduced breast and thyroid dose.
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Affiliation(s)
- T David Luo
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Beth A Schueler
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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