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New EOS Imaging Protocol Allows a Substantial Reduction in Radiation Exposure for Scoliosis Patients

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Abstract

Study Design

Prospective.

Objective

To evaluate the reliability of three-dimensional (3D) spinal models from Micro Dose EOS x-rays compared to standard, Low Dose EOS x-rays utilized for evaluating patients with adolescent idiopathic scoliosis (AIS).

Summary of Background Data

There is a strong suggestion that radiation exposure to scoliosis patients can be further reduced.

Methods

Sixty AIS patients who received biplanar, posteroanterior, and lateral standard Low Dose spine x-rays in our EOS imaging unit (∼0.33 mGy) as part of routine care also underwent an additional set of new reduced “Micro Dose” EOS x-rays (∼0.05 mGy) using a recently developed protocol. Two measurers created 3D models of the images using sterEOS software (Low Dose x2, Micro Dose x2). From this 3D modeling software, coronal Cobb angles, sagittal (T1–T12, T4–T12, L1–L5, L1–S1), and apical axial rotation measurements were obtained. Intraclass correlations (ICCs) and standard error of measurement (upper bound of 95% confidence interval) for the differences between Low Dose and Micro Dose measurements were compared. Interrater reliability was assessed on standard two-dimensional (2D) radiographic measurements.

Results

The ICCs were rated as “substantial” to “almost perfect” for Low Dose 3D, Micro Dose 3D, and 2D measures (range 0.78–0.99). The calculated measurement error was not significantly different between groups except for intrarater error on 3D L1–L5 lordosis (2.9° Micro Dose vs. 2.2°, p =.04), interrater 3D rotation of the lumbar apex (2.6° Micro Dose vs. 1.7°, p =.03), and 2D T12–sacrum lordosis (4.6° Micro Dose vs. 3.4°, p =.04).

Conclusions

Although statistically significant differences in average measurement error were observed in lordosis and lumbar apex rotation, these differences are not believed to be clinically significant. The Micro Dose images have slightly less clarity qualitatively, yet the critical 2D and 3D measures of the curvature were reliably measured with error of measurement comparable to standard radiologic techniques.

Level of Evidence

Level I, Diagnostic.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, Rady Children’s Hospital, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Peter O. Newton MD, Carrie E. Bartley MA, Fredrick G. Reighard MPH, Tracey P. Bastrom MA & Burt Yaszay MD

  2. School of Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92023, USA

    Yash Khandwala BS

Authors
  1. Peter O. Newton MD
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  2. Yash Khandwala BS
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  3. Carrie E. Bartley MA
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  4. Fredrick G. Reighard MPH
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  5. Tracey P. Bastrom MA
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  6. Burt Yaszay MD
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Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

This study was conducted at Rady Children’s Hospital, San Diego, CA.

Author disclosures

PON (grants from EOS Imaging, during the conduct of the study; grants and other from POSNA, grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Norcal, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, outside the submitted work; In addition, Dr. Newton has a patent Anchoring Systems and Methods for correcting Spinal Deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low Profile Spinal Tethering Systems (8123749) issued to DePuy Spine, Inc, a patent Screw Placement Guide (7981117) issued to DePuy Spine, Inc, and a patent Compressor for Use in Minimally Invasive Surgery (7189244) issued to DePuy Spine, Inc), YK (grants from EOS Imaging, during the conduct of the study), CEB (grants from EOS Imaging, during the conduct of the study), FGR (grants from EOS Imaging, during the conduct of the study), TPB (grants from EOS Imaging, during the conduct of the study), BY (reports grants from EOS Imaging, during the conduct of the study; grants and personal fees from K2M, grants and personal fees from Depuy Synthes Spine, personal fees from Medtronic, personal fees from Nuvasive, grants from KCI, grants from POSNA, personal fees from Orthopediatrics, grants and personal fees from Ellipse, personal fees from Globus, outside the submitted work; in addition, BY has a patent Adjustable Axial Spinal Rod Connector (20140066989) issued to K2M, and a patent Flexible Fastening System (20140257397) issued to K2M).

IRB approval was obtained for this study.

This study was supported by a grant from EOS Imaging.

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Newton, P.O., Khandwala, Y., Bartley, C.E. et al. New EOS Imaging Protocol Allows a Substantial Reduction in Radiation Exposure for Scoliosis Patients. Spine Deform 4, 138–144 (2016). https://doi.org/10.1016/j.jspd.2015.09.002

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  • DOI: https://doi.org/10.1016/j.jspd.2015.09.002

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