EOS^® biplanar X-ray imaging: Concept, developments, benefits, and limitations

Abstract

PurposeIn 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS® 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS® imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations.MethodsThe review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS® system.ResultsWhile EOS® imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan.ConclusionsThe major advantages of EOS® are the relatively low dose of radiation (50–80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS® imaging technique has proven itself to be a very useful research and diagnostic tool.

Comparison of Radiation Exposure to the Patient and Contrast Detail Resolutions Across Low Dose 2d/3d Slot Scanner and Two Conventional Digital Radiography X-Ray Imaging Systems

“…To our knowledge, the MDSS X-ray imaging system is currently not used for diagnostic X-ray examinations, as comprehensive studies to determine whether this system can be used for other anatomical regions have not been undertaken. There is an indication that the MDSS imaging system has a potential for use as a conventional radiographic imaging system 13 . It has also been shown that the image quality of the MDSS imaging system is comparable to that of conventional DR imaging systems for the clinical spine protocol 14 .…”

EOS Micro-dose Protocol: First Full-spine Radiation Dose Measurements in Anthropomorphic Phantoms and Comparisons with EOS Standard-dose and Conventional Digital Radiology

“…The EOS low-dose imaging system (EOS imaging®, Paris, France) has been developed to produce high quality images at low radiation doses 6 . We have been using the EOS scanner for full-spine examinations at our institution, since the fall of 2014.…”

Combining acetabular and femoral morphology improves our understanding of the down syndrome hip

“…Such differences between previous studies have been suggested to be partly due to the difficulty in standardizing these patients' positioning during X-ray acquisition (Kelley and Wedge, 2013), especially in the presence of hip rotation. In this study, the use of biplanar X-rays with three-dimensional reconstruction for the assessment of hip anatomy, which has been previously shown to decrease the effect of patient positioning bias (Melhem et al, 2016), should have allowed precise evaluation of the anatomy of the Down syndrome hip.…”