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A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system

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To evaluate the available evidence for the clinical effectiveness of the EOS® 2D/3D X-ray imaging system for the evaluation and monitoring of scoliosis and other relevant orthopaedic conditions.


A systematic review of studies of EOS®, compared with standard X-ray film, computed radiography or digital radiography, of patients with orthopaedic conditions was undertaken. Ten electronic databases were searched. The quality of the included studies was assessed and a narrative synthesis undertaken.


Three small, limited quality studies, primarily of children with scoliosis, were identified. No patient health outcomes were reported. Spinal image quality was comparable or better overall with EOS®. Radiation dose was considerably lower with EOS® than X-ray film or computed radiography; the mean entrance surface dose was over five times lower with EOS® for the posteroanterior spine radiograph and over six times lower for the lateral spine radiograph.


The available clinical evidence for EOS® is limited to establishing its basic technical ability. The technical advancements associated with EOS® (the ability to generate a full body scan and to construct a three-dimensional model from synchronously acquired lateral and posteroanterior images) have not been evaluated in terms of their ability to improve patient outcomes. Whilst radiation dose is a concern for orthopaedic patients who require repeated imaging, it is difficult to quantify the reductions in radiation dose seen with EOS® in terms of patient health benefits. Clinical studies that investigate the impact of EOS® on patient management are required.

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We would like to thank Lisa Stirk, Information Specialist at the Centre for Reviews and Dissemination for devising the search strategy and carrying out the literature searches. We would like to thank the following for providing clinical advice: Professor Jeremy Fairbank, Consultant Orthopaedic Surgeon, Nuffield Orthopaedic Centre NHS Trust; Dr David Grier, Consultant Paediatric Radiologist, Bristol Royal Hospital for Children; Mr Peter Millner, Consultant Orthopaedic and Spinal Surgeon, Leeds Teaching Hospitals NHS Trust; Dr James Rankine, Consultant Radiologist, Leeds Teaching Hospitals NHS Trust. This report was commissioned by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme on behalf of the National Institute for Health and Clinical Excellence (NICE) as project number HTA 10/67/01. The views expressed are those of the authors and not necessarily those of the NIHR HTA Programme. Any errors are the responsibility of the authors.

Conflict of interest

Nigel Gummerson has received travel, accommodation and course expenses unrelated to this piece of work from the following spinal implant companies: Biomet, DePuy, Zimmer, K2M, Medtronic and Synthes.

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Correspondence to Ros Wade.

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Wade, R., Yang, H., McKenna, C. et al. A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 22, 296–304 (2013).

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