Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system

Hirsch, C.; Ilharreborde, Brice; Mazda, Keyvan

doi:10.1016/j.otsr.2016.01.021

Cited by 32 publications

(21 citation statements)

References 23 publications

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“…13 EOS has also proven equivalent to conventional radiography in the evaluation of preoperative spinal flexibility. 15 Furthermore, in the 1 patient with a vagus nerve stimulator (VNS) in our study, EOS demonstrated excellent resolution of the hardware (Fig. 2).…”

Section: Discussionmentioning

confidence: 55%

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

Monuszko

Malinzak²,

Yang

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPatients with shunted hydrocephalus often accumulate high levels of radiation over their lifetimes during evaluation of hardware integrity. Current practice involves the use of a series of conventional radiographs for this purpose. Newer low-dose EOS radiography is currently used to evaluate scoliosis but has not been explored to evaluate shunt integrity on a large scale. The goal of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate shunt tubing.METHODSA retrospective chart review was performed on 57 patients who previously had both conventional radiographs and low-dose EOS images of their cerebral shunt tubing from 2000 to 2018. Patient demographics (age, sex, type of shunt tubing, primary diagnosis) were collected. Conventional radiographic images and low-dose EOS images were independently analyzed by a neurosurgeon and neuroradiologist in three categories: image quality, delineation of shunt, and distinction of shunt compared to adjacent anatomy.RESULTSAll patients had shunted hydrocephalus due to spina bifida and Chiari type II malformation. Ratings of EOS and conventional radiographic images by both raters did not differ significantly in terms of image quality (rater 1, p = 0.499; rater 2, p = 0.578) or delineation of shunt (p = 0.107 and p = 0.256). Conventional radiographic images received significantly higher ratings than EOS on the ability to distinguish the shunt versus adjacent anatomy by rater 1 (p = 0.039), but not by rater 2 (p = 0.149). The overall score of the three categories combined was not significantly different between EOS and conventional radiography (rater 1, p = 0.818; rater 2, p = 0.186). In terms of cost, an EOS image was less costly than a conventional radiography shunt series ($236–$366 and $1300–$1547, respectively). The radiation dose was also lower for EOS images, with an effective dose of 0.086–0.140 mSv compared to approximately 1.6 mSv for a similar field of view with conventional radiography.CONCLUSIONSThe image quality of low-dose EOS radiography does not significantly differ from conventional radiography for the evaluation of cerebral shunts. In addition, EOS affords a much lower radiation dose and a lower cost.

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Section: Discussionmentioning

confidence: 55%

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

Monuszko

Malinzak²,

Yang

et al. 2021

Journal of Neurosurgery: Pediatrics

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“…Coupled axial rotation generally occurred in the same direction as lateral bending. The standing side-bending images of the EOS device contributed the same results as the supine images, with a five times lower radiation dose [21]. Nevertheless, none of these techniques were referred to specify the LIV.…”

Section: Discussionmentioning

confidence: 85%

The Role of Bending Films in the Lowest Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis Lenke Type 1A,B Based on Asymmetrical Disc Loading and Decompensation

et al. 2022

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Patients with severe adolescent idiopathic scoliosis (AIS) require instrumented spinal fusion surgery. The range of instrumented vertebra is still questioned, especially the selection of the lowest instrumented vertebra (LIV). This single institution retrospective consecutive study is to provide real-world data on outcomes. The study aims to assess whether bending films can determine the LIV. The method of determination of the lower tilted vertebra (LTV) is presented. The selection of the LTV was identified on standing PA (LTVs) and on bending X-rays (LTVb). Group A is a reference group, with less flexible curves. Groups B and C contained patients with more flexible curves. Group B covered patients with instrumentation ending at the LTVs and group C with shorter instrumentation ending at LTVb. The disc angle below the LIV was monitored for postoperative decompensation. Sixty-eight subjects with AIS Lenke 1A and 1B types underwent selective fusion. The decompensation criteria of the unfused disc below the fusion were determined as a wedging disk of >5° of the Cobb angle. The patients were monitored during the postoperative period with 5.8 years average followup (minimum of 2 years). The rate of decompensation was comparable in groups A and B (31% and 33%, respectively). In contrast, the rate of decompensation was doubled in group C (60%). Caudal fusion shortening in more flexible curves according to bending films is associated with the first free disc asymmetry, which leads to decompensation below the fusion. This method should be considered in addition to other LIV selection criteria.

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“…Indeed, for a three-dimensional assessment of scoliosis, biplanar radiographs are acquired when possible, since they allow 3D reconstruction of the bony structures [21,22]. It is possible that feeding radiographs with patients in different position (such as in lateral bending [23]) could alter the results. Nevertheless, the sample can be considered heterogeneous since the radiographs were acquired from five different hospitals in a time span of about 8 years.…”

Section: Discussionmentioning

confidence: 99%

A convolutional neural network to detect scoliosis treatment in radiographs

2020

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The aim of this work is to propose a classification algorithm to automatically detect treatment for scoliosis (brace, implant or no treatment) in postero-anterior radiographs. Such automatic labelling of radiographs could represent a step towards global automatic radiological analysis. Methods Seven hundred and ninety-six frontal radiographies of adolescents were collected (84 patients wearing a brace, 325 with a spinal implant and 387 reference images with no treatment). The dataset was augmented to a total of 2096 images. A classification model was built, composed by a forward convolutional neural network (CNN) followed by a discriminant analysis; the output was a probability for a given image to contain a brace, a spinal implant or none. The model was validated with a stratified tenfold cross-validation procedure. Performance was estimated by calculating the average accuracy. Results 98.3% of the radiographs were correctly classified as either reference, brace or implant, excluding 2.0% unclassified images. 99.7% of brace radiographs were correctly detected, while most of the errors occurred in the reference group (i.e. 2.1% of reference images were wrongly classified). Conclusion The proposed classification model, the originality of which is the coupling of a CNN with discriminant analysis, can be used to automatically label radiographs for the presence of scoliosis treatment. This information is usually missing from DICOM metadata, so such method could facilitate the use of large databases. Furthermore, the same model architecture could potentially be applied for other radiograph classifications, such as sex and presence of scoliotic deformity.

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Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system

Abstract: 2.

Cited by 32 publications

References 23 publications

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

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

The Role of Bending Films in the Lowest Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis Lenke Type 1A,B Based on Asymmetrical Disc Loading and Decompensation

A convolutional neural network to detect scoliosis treatment in radiographs

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