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EOS microdose protocol for the radiological follow-up of adolescent idiopathic scoliosis

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Abstract

Purpose

Imaging plays a key role in adolescent idiopathic scoliosis (AIS) to determine the prognosis and accordingly define the best therapeutic strategy to follow. Conventional radiographs with ionizing radiation have been associated with 1–2 % increased lifetime risk of developing cancer in children, and physicians, therefore, need a sensitive but harmless way to explore patients at risk, according to the “as low as reasonably achievable” concept. The EOS system (EOS imaging, Paris, France) is available in routine clinical use since 2007, and allows 3D reconstructions of the trunk in standing position with significant radiation reduction. With recent technical advances, further dose reduction can be obtained, but at the cost of image quality that might alter the reliability of 3D reconstructions. The aim of the present study was to analyze the reproducibility of a “microdose” protocol, and evaluate its use in clinical practice.

Methods

32 consecutive patients followed for AIS were prospectively included. Biplanar radiographs were obtained with the EOS system according to the new microdose protocol. From the microdose images obtained, three experienced operators performed 3D reconstructions, two times for each subject in a random order (total, 192 reconstructions). The intraoperator repeatability and interoperator reproducibility were evaluated, as recommended by the International Organization for Standardization, for the most clinically relevant 3D radiological parameters.

Results

The identification of the required anatomical landmarks for the “fast spine” reconstruction process was possible in all cases. None of the patients required a second acquisition for 3D analysis. Mean time for reconstruction was 5 ± 2 min. The intraoperator repeatability was better than interoperator reproducibility for all parameters, with values ranging between 3° and 8° for frontal and sagittal spinal parameters, and between 1° and 8° for pelvic measurements. The agreement was very good for all clinical measurements. No correlation was found between the BMI and the reliability of the measurements.

Conclusions

Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of imaging methods and a search for newer technologies remain necessary. Results of the current study show that the new microdose acquisition protocol can be used in clinical practice without altering the quality of the images. Relevant clinical measurements can be made manually, but the landmarks are also visible enough to allow accurate 3D reconstructions (ICC >0.91 for all parameters). The resulting radiation exposure was 5.5 times lower than that received with the prior protocol, corresponding now to a 45-fold reduction compared to conventional radiographs, and can, therefore, almost be considered negligible.

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References

  1. Bone CM, Hsieh GH (2000) The risk of carcinogenesis from radiographs to pediatric orthopaedic patients. J Pediatr Orthop 20:251–254

    PubMed  CAS  Google Scholar 

  2. ICRP, Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K,Sanchez R (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 42(2):1–63

  3. Labelle H, Aubin CE, Jackson R, Lenke L, Newton P, Parent S (2011) Seeing the spine in 3D: how will it change what we do? J Pediatr Orthop 31:S37–S45

    Article  PubMed  Google Scholar 

  4. Ilharreborde B, Sebag G, Skalli W, Mazda K (2013) Adolescent idiopathic scoliosis treated by posteromedial translation: radiologic evaluation with a 3D low-dose system. Eur Spine J 22:2382–2391

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hong JY, Suh SW, Easwar TR, Modi HN, Yang JH, Park JH (2011) Evaluation of the three-dimensional deformities in scoliosis surgery with computed tomography: efficacy and relationship with clinical outcomes. Spine (Phila Pa 1976) 36:E1259–E1265

  6. Ilharreborde B, Dubousset J, Le Huec JC (2014) Use of EOS imaging for the assessment of scoliosis deformities: application to postoperative 3D quantitative analysis of the trunk. Eur Spine J 23(Suppl 4):S397–S405

    PubMed  Google Scholar 

  7. Ilharreborde B, Steffen JS, Nectoux E, Vital JM, Mazda K, Skalli W, Obeid I (2011) Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 36:E1306–E1313

  8. ISO 5725-2:1994/Cor 1: 2002 Accuracy (trueness and precision) of measurement methods and results—part 2: basic method for the determination of repeatability and reproducibility of a standard measurement method: international organization for standardization. http://www.iso.org

  9. Hresko MT (2013) Clinical practice: idiopathics scoliosis in adolescents. N Engl J Med 368:834–841

    Article  PubMed  CAS  Google Scholar 

  10. Mettler FA, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, Lipoti JA, Mahesh M, McCrohan JL, Stabin MG, Thomadsen BR, Yoshizumi TT (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology 253:520–531

    Article  PubMed  Google Scholar 

  11. Presciutti SM, Karukanda T, Lee M (2014) Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure. Spine J 14:1984–1990

    Article  PubMed  Google Scholar 

  12. Smith-Bindman R, Miglioretti DL, Johnson E et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA 307:2400–2409

    Article  PubMed  CAS  Google Scholar 

  13. Thorne MC (1987) Principles of the international commission on radiological protection system of dose limitation. Br J Radiol 60:32–38

    Article  PubMed  CAS  Google Scholar 

  14. Courvoisier A, Drevelle X, Dubousset J, Skalli W (2013) Transverse plane 3D analysis of mild scoliosis. Eur Spine J 22:2427–2432

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nault ML, Mac-Thiong JM, Roy-Baudry M, Turgeon I, Deguise J, Labelle H, Parent S (2014) Three-dimensional spinal morphology can differentiate between progressive and non-progressive patients with adolescent idiopathic scoliosis at the initial presentation: a prospective study. Spine 39:E 601–E 606

  16. Richards PJ, George J, Metelko M, Brown M (2010) Spine computed tomography doses and cancer induction. Spine (Phila Pa 1976) 35:430–433

  17. Museyko O, Heinemann A, Krause M et al (2014) A low-radiation exposure protocol for 3D QCT of the spine. Osteoporos Int 25:983–992

    Article  PubMed  CAS  Google Scholar 

  18. Alshamari M, Geijer M, Norman E, Geijer H (2014) Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality. Acta Radiol 55:824–832

    Article  PubMed  Google Scholar 

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Conflict of interest

The departments of Pediatric Radiology and Pediatric Orthopaedics of Robert Debré Hospital have received research funds from the company EOS Imaging in the past 2 years, but it was not related to this specific study which was independent.

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Authors and Affiliations

  1. Department of Pediatric Orthopaedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Bd Sérurier, 75019, Paris, France

    Brice Ilharreborde, Emmanuelle Ferrero & Keyvan Mazda

  2. Department of Pediatric Radiology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France

    Marianne Alison

Authors
  1. Brice Ilharreborde
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  2. Emmanuelle Ferrero
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  3. Marianne Alison
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  4. Keyvan Mazda
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Correspondence to Brice Ilharreborde.

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Ilharreborde, B., Ferrero, E., Alison, M. et al. EOS microdose protocol for the radiological follow-up of adolescent idiopathic scoliosis. Eur Spine J 25, 526–531 (2016). https://doi.org/10.1007/s00586-015-3960-8

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  • DOI: https://doi.org/10.1007/s00586-015-3960-8

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