HSS Journal ®

, Volume 13, Issue 3, pp 263–266 | Cite as

Reliability and Reproducibility of Subject Positioning with EOS Low-Dose Biplanar X-ray

  • Christine Goodbody
  • Paz Kedem
  • Michaela Thompson
  • Huong T. Do
  • Douglas N. Mintz
  • Roger F. Widmann
  • Emily R. Dodwell
Original Article



EOS low-dose biplanar X-ray used with tantalum bead implantation is an appealing imaging modality to evaluate limb length and physeal growth due its relatively low radiation exposure, excellent inter- and intra-observer reliability, and minimal magnification/shrinkage error.


The purpose of this study was to establish the error in total length and inter-bead distances using EOS and tantalum beads due to variable positioning in the EOS gantry, by assessing variation in measurements made on the same subject repeatedly positioning by one positioner (intra-positioner measurement error) and variation in measurements made on the same subject with positioning by multiple positioners (inter-positioner measurement error).


Tantalum bead markers were placed about the distal femoral physis of a cadaveric lamb femur. Three investigators positioned the femur in the EOS gantry 10 times, totaling 30 EOS scans. Total limb length and inter-bead distances were measured on AP and lateral views; mean and standard error were calculated. A random effects analysis of variance for nested data was used to determine the proportion of variation due to differences between positioners and differences between positioning by the same positioner.


Intra-positioner measurement error ranged from 0.01 to 0.06 mm. Inter-positioner measurement error ranged from 0.00 to 0.09 mm.


EOS has relatively low radiation and allows standing assessment of limb length and alignment. In this study, length measurements and inter-bead distances demonstrated minimal error due to positioning in the EOS gantry, documenting that there is minimal error from positioning, minimal magnification/shrinkage error, and exceptional inter and intra-rater reliability. EOS is the preferred method for length and angular measurements, and with tantalum beads, is ideal for measuring growth about the physis.


tantalum beads positioning EOS measurement reproducibility repeatability inter-positioner intra-positioner reliability error 


Compliance with Ethical Standards

Conflict of Interest:

Christine Goodbody, MD, Paz Kedem, MD, Michaela Thompson, BA, Roger F. Widmann, MD and Emily R. Dodwell, MD, MPH, FRCSC have declared that they have no conflict of interest. Huong T. Do, MA, reports grants from Clinical and Translational Science Center, outside the work. Douglas N. Mintz, MD, FACR, reports personal fees from Current Concepts in Rheumatology and other from Virtualscopics, outside the work.

Human/Animal Rights

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent



This study was funded through Hospital for Special Surgery Pediatric Council Research Grant.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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Copyright information

© Hospital for Special Surgery 2017

Authors and Affiliations

  • Christine Goodbody
    • 1
  • Paz Kedem
    • 1
  • Michaela Thompson
    • 1
  • Huong T. Do
    • 1
  • Douglas N. Mintz
    • 1
  • Roger F. Widmann
    • 1
  • Emily R. Dodwell
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA

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