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Three-dimensional biplanar radiography as a new means of accessing femoral version: a comparitive study of EOS three-dimensional radiography versus computed tomography

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Abstract

Objective

To validate femoral version measurements made from biplanar radiography (BR), three-dimensional (3D) reconstructions (EOS imaging, France) were made in differing rotational positions against the gold standard of computed tomography (CT).

Materials and methods

Two cadaveric femurs were scanned with CT and BR in five different femoral versions creating ten total phantoms. The native version was modified by rotating through a mid-diaphyseal hinge twice into increasing anteversion and twice into increased retroversion. For each biplanar scan, the phantom itself was rotated −10, −5, 0, +5 and +10°. Three-dimensional CT reconstructions were designated the true value for femoral version. Two independent observers measured the femoral version on CT axial slices and BR 3D reconstructions twice. The mean error (upper bound of the 95 % confidence interval), inter- and intraobserver reliability, and the error compared to the true version were determined for both imaging techniques.

Results

Interobserver intraclass correlation for CT axial images ranged from 0.981 to 0.991, and the intraobserver intraclass correlation ranged from 0.994 to 0.996. For the BR 3D reconstructions these values ranged from 0.983 to 0.998 and 0.982 to 0.998, respectively. For the CT measurements the upper bound of error from the true value was 5.4–7.5°, whereas for BR 3D reconstructions it was 4.0–10.1°. There was no statistical difference in the mean error from the true values for any of the measurements done with axial CT or BR 3D reconstructions.

Conclusion

BR 3D reconstructions accurately and reliably provide clinical data on femoral version compared to CT even with rotation of the patient of up to 10° from neutral.

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Acknowledgments

The authors wish to acknowledge Tracey Bastrom for her statistical assistance and Christine Farnsworth for assistance with completion of the manuscript.

Conflict of interests

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Orthopaedic Surgery Department, University of California San Diego School of Medicine, San Diego, USA

    M. Lucius Pomerantz & Eric W. Edmonds

  2. Aurora Spine, Carlsbad, CA, USA

    Diana Glaser

  3. Orthopedic Biomechanics Research Center, San Diego, CA, USA

    Josh Doan

  4. Student of Bioengineering, University of California San Diego, San Diego, USA

    Sita Kumar

  5. Division of Orthopedic Surgery, Rady Children’s Hospital San Diego, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Eric W. Edmonds

Authors
  1. M. Lucius Pomerantz
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  2. Diana Glaser
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  3. Josh Doan
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  4. Sita Kumar
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  5. Eric W. Edmonds
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Correspondence to Eric W. Edmonds.

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Pomerantz, M.L., Glaser, D., Doan, J. et al. Three-dimensional biplanar radiography as a new means of accessing femoral version: a comparitive study of EOS three-dimensional radiography versus computed tomography. Skeletal Radiol 44, 255–260 (2015). https://doi.org/10.1007/s00256-014-2031-2

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  • DOI: https://doi.org/10.1007/s00256-014-2031-2

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