Peter H Pedersen1,2,3, Claudio Vergari4, Abdulmajeed Alzakri4,5, Raphaël Vialle6, Wafa Skalli4. 1. Orthopedic Department, University Hospital of Aalborg, Hobrovej 18-22, 9000, Aalborg, Denmark. php@rn.dk. 2. Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France. php@rn.dk. 3. Department of Pediatrics, Sorbonne Université, APHP Paris, 26 avenue du Dr Arnold Netter, 75012, Paris, France. php@rn.dk. 4. Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France. 5. Orthopedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. 6. Department of Pediatrics, Sorbonne Université, APHP Paris, 26 avenue du Dr Arnold Netter, 75012, Paris, France.
Abstract
PURPOSE: The aim of this study was to validate the reproducibility of 3D reconstructions of the spine using a new reduced micro-dose protocol. METHODS: First, semi-quantitative image analysis was performed using an anthropomorphic child phantom undergoing low-dose biplanar radiography. This analysis was used to establish a "lowest dose" allowing for acceptable visibility of spinal landmarks. Subsequently, a group of 18 scoliotic children, 12 years of age or younger, underwent full-spine biplanar radiography with both micro-dose and the newly defined reduced micro-dose. An intra- and inter-observer reliability study of 3D reconstructions of the spine was performed according to the International Organization for Standardization (ISO)-5725 standard, with three operators. RESULTS: The reduced micro-dose setting corresponded to a theoretical reduction of radiation dose exposure of approximately 58%. In vivo results showed acceptable intra- and inter-observer reliability (for instance, 3.8° uncertainty on Cobb angle), comparable to previous studies on 3D spine reconstruction reliability and reproducibility based on stereo-radiography. CONCLUSION: A new reduced micro-dose protocol offered reliable 3D reconstructions of the spine in patients with mild scoliosis. However, the quality of 3D reconstructions from both reduced micro-dose and micro-dose was inferior to standard-dose protocol on most parameters. Standard-dose protocol remains the option of choice for most accurate assessment and 3D reconstruction of the spine. Still, this new protocol offers a preliminary screening option and a follow-up tool for children with mild scoliosis yielding extremely low radiation and could replace micro-dose protocol for these patients. KEY POINTS: • We investigated the reliability of 3D reconstructions of the spine based on a new stereo-radiography protocol reducing radiation dose by 58% compared with established micro-dose imaging protocol. • The new reduced micro-dose protocol offers a reproducible preliminary screening option and a follow-up tool in the necessarily frequent repeat imaging of children with mild scoliosis yielding extremely low radiation and could replace existing micro-dose protocol for these patients. • EOS standard-dose protocol remains the option of choice for exact radiographic assessment of scoliosis, offering more exact 3D reproducibility of the spine compared to both micro-dose and the new reduced micro-dose protocols.
PURPOSE: The aim of this study was to validate the reproducibility of 3D reconstructions of the spine using a new reduced micro-dose protocol. METHODS: First, semi-quantitative image analysis was performed using an anthropomorphic child phantom undergoing low-dose biplanar radiography. This analysis was used to establish a "lowest dose" allowing for acceptable visibility of spinal landmarks. Subsequently, a group of 18 scoliotic children, 12 years of age or younger, underwent full-spine biplanar radiography with both micro-dose and the newly defined reduced micro-dose. An intra- and inter-observer reliability study of 3D reconstructions of the spine was performed according to the International Organization for Standardization (ISO)-5725 standard, with three operators. RESULTS: The reduced micro-dose setting corresponded to a theoretical reduction of radiation dose exposure of approximately 58%. In vivo results showed acceptable intra- and inter-observer reliability (for instance, 3.8° uncertainty on Cobb angle), comparable to previous studies on 3D spine reconstruction reliability and reproducibility based on stereo-radiography. CONCLUSION: A new reduced micro-dose protocol offered reliable 3D reconstructions of the spine in patients with mild scoliosis. However, the quality of 3D reconstructions from both reduced micro-dose and micro-dose was inferior to standard-dose protocol on most parameters. Standard-dose protocol remains the option of choice for most accurate assessment and 3D reconstruction of the spine. Still, this new protocol offers a preliminary screening option and a follow-up tool for children with mild scoliosis yielding extremely low radiation and could replace micro-dose protocol for these patients. KEY POINTS: • We investigated the reliability of 3D reconstructions of the spine based on a new stereo-radiography protocol reducing radiation dose by 58% compared with established micro-dose imaging protocol. • The new reduced micro-dose protocol offers a reproducible preliminary screening option and a follow-up tool in the necessarily frequent repeat imaging of children with mild scoliosis yielding extremely low radiation and could replace existing micro-dose protocol for these patients. • EOS standard-dose protocol remains the option of choice for exact radiographic assessment of scoliosis, offering more exact 3D reproducibility of the spine compared to both micro-dose and the new reduced micro-dose protocols.
Entities:
Keywords:
Radiation dosage; Radiography; Reproducibility of results; Scoliosis; Three-dimensional imaging