Can EOS Imaging Substitute for Conventional Radiography in Measurement of Acetabular Morphology in the Young Dysplastic Hip?

Abstract

Background: EOS imaging offers a low-radiation alternative to conventional radiography (CR) and has little to no magnification effects. However, it is unclear how radiographic measures may be affected using EOS. The present study aims to determine the reproducibility of measures of acetabular morphology on EOS images as compared with CR, and to directly compare the 2 imaging modalities. Methods: A total of 21 consecutive patients (66.7% female; 14.4±4.7 y) indicated for an open hip preservation procedure with both an anterior-posterior pelvis radiograph and EOS image performed preoperatively were included. Three orthopaedic surgeons measured Tönnis angle, lateral center edge angle (LCEA), acetabular depth-width ratio (ADR), and extrusion index (EI). Measurements were performed twice, 2 weeks apart. Reliability between observers and time points was measured using intraclass correlation coefficients, and agreement between time points and modalities was measured using Bland-Altman analysis. Results: On EOS images, inter-rater reliability was 0.86 for Tönnis angle, 0.86 for LCEA, 0.74 for ADR, and 0.93 for EI. On CR, inter-rater reliability was 0.86 for Tönnis anlge, 0.90 for LCEA, 0.82 for ADR, and 0.84 for EI. In the agreement analysis, biases between imaging modalities were observed. On average, raters measured Tönnis angle and EI higher on EOS images than CR (2.22 degrees, 1.09%, respectively); and LCEA and ADR lower on EOS images than CR (1.54 degrees, 1.14% respectively). Limits of agreement (LOA) between modalities were similar to that of LOA observed in intra-rater analysis. Conclusions: Measures of acetabular morphology performed on EOS images have similarly high intra-rater and inter-rater reliability compared with CR. Measures performed on EOS also have similar intra-rater agreement as compared with CR. Intermodality agreement had similar LOA as intra-rater agreement on either individual imaging modality. Small biases between imaging modalities were detected. Levels of Evidence: Level I—diagnostic study: investigating a diagnostic test.

Image quality of EOS low-dose radiography in comparison with conventional radiography for assessment of ventriculoperitoneal shunt integrity

“…3) and increased risk of motion artifacts, especially in pediatric patients, due to a slow image acquisition process. 21 However, given that EOS appears to be equivalent to radiography for spine, hip, and chest imaging, 13,14 and putatively shunt This study has several limitations. It is retrospective and included only patients with shunted hydrocephalus due to Chiari type II malformations.…”

“…Orthopedic studies have compared EOS scans to conventional radiographs and found noninferior radiographs without distortions when analyzing spinal and pelvic angles and measurements. 13,14 A study by Hey et al compared full-body EOS images to conventional chest radiographic images for preoperative evaluation of patients undergoing spine surgery and found no significant differences between the two imaging modalities. 13 EOS has also proven equivalent to conventional radiography in the evaluation of preoperative spinal flexibility.…”

Hip Morphology in Early-stage LCPD: Is There an Argument for Anatomic-specific Containment?

“…While an interrater reliability analysis was not conducted, previously reported ICC for all measures included have been shown to be excellent. 23 This study includes patients from multiple sites and represents an international cohort of early-stage LCPD patients which improves its generalizability.…”

“…21,22 All measurements were performed by 3 authors specifically for the purpose of this study (C.M.S., J.T.B., and W.N.S.). Intrarater and interrater reliability has been previously measured in multiple studies, and intraclass correlation coefficients (ICC) values have been well-established for the following metrics: EI (0.80 to 0.96); LCEA (0.64 to 0.97); AI/Tönnis (0.42 to 0.95) 23. Given these well-established ICC values, each observer measured one-third of the radiographs included in the study.…”

A Semi-automatic Diagnosis of Hip Dysplasia on X-Ray Films

“…Although three dimensional structure of hip joint can be derived from CT and MRI images, it has to be faced with relatively high fees of medical check and high radiation. Therefore, the radiograph of pelvis from a X-ray film becomes the main early diagnosis of hip dysplasia (Kayaalp et al, 2020;Powell et al, 2020). Inevitably, the ever-growing numbers of X-ray films increase the burden of radiologists.…”