Radiation Reduction Strategies in Pediatric Orthopaedics

Sawyer, Jeffrey R.

doi:10.1097/bpo.0000000000001822

Cited by 6 publications

(4 citation statements)

References 54 publications

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“…4 Technological improvements have led to improved image quality using less radiation. 1,5,6,12 The EOS system (EOS imaging, Paris, France), the most significant innovation in recent years, uses biplanar stereoradiography to produce images with low radiation. In the pediatric scoliosis population the use of EOS shows a mean reduction of 2.72 mSv or 0.91 years of background radiation over a 4.5 year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

Nowell¹,

Murray²,

Oetgen³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Fractures are typically evaluated and monitored using plain radiographs, but in the pediatric population the goal is always to reduce radiation exposure when possible. Dual-energy x-ray absorptiometry (DEXA) is an imaging modality that uses less radiation. The evaluation of upper and lower extremity fractures in the pediatric population using DEXA imaging has not yet been studied. Method: Radiographs of 19 patients treated for forearm or tibia fractures were compared to images taken with a DEXA machine. The angulation and translation of the fractures were measured twice each by two independent observers. Correlation of these values between plain radiographs and DEXA scans along with intra and inter-observer reliability was calculated. Results: A total of 19 patients with a forearm or tibia fracture were enrolled in the study. Correlation with conventional radiographs for angulation was r=0.77, p<0.001, while for translation it was r=0.76, p<0.001. The mean difference between the methods was 0.5 degrees (range of -6.7 to 7.7) for angulation and 4% (range of -28% to 37%) for translation. For plain radiographs, the inter-rater reliability was 0.90 (95% confidence interval of 0.84-0.93) for angulation and 0.89 (0.68-0.95) for translation. The inter-rater reliability for DEXA imaging was 0.77 (0.69-0.83) for angulation and 0.76(0.41-0.88) for translation. Conclusion: Our study showed that DEXA imaging correlates well with plain radiographs when measuring angulation and translation of forearm and tibia fractures in the pediatric population. This study is a proof of concept that DEXA, a low-dose radiation alternative to plain radiographs, may be useful in the management of pediatric fractures.

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Section: Discussionmentioning

confidence: 99%

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

Nowell¹,

Murray²,

Oetgen³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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“…CT is also an option for assessment, but is not suggested given the increased radiation, inferior soft tissue contrast, and limited additional information beyond that of MRI, especially in paediatric populations [29, 50]. Although ultrasound is not often used, there is increasing evidence for its utility in MSK diagnoses [40].…”

Section: Discussionmentioning

confidence: 99%

MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

Qiu

Fitzpatrick

Cohen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following traumatic patellar dislocation. MethodsAccording to the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA), MEDLINE, EMBASE, Web of Science, and PubMed were searched for results from January 1, 2000, to May 18, 2021, in two subsequent searches for English language studies that presented data on traumatic patellar dislocation. Quality of selected papers was assessed using the Methodological Index for Non‐Randomised Studies (MINORS) and the Risk of Bias (RoB) 2.0 protocol. Results were qualitatively synthesised, and descriptive statistics were calculated. ResultsForty studies totalling 3074 patients (1407 females) were included for the analysis. The mean age was 18.9 years (range 0–69). The population included 2446 first‐time dislocations. The imaging modalities used were: 71.1% MRI, 52.6% plain radiography, 12.1% CT, and 0.68% ultrasound. In the 25 studies that reported the number of OCF, a total of 38.3% of patients were found to have OCF. 43.3% of patients with a first‐time dislocation, and 34.7% of patients with previous dislocations, had at least one OCF. In the included paediatric studies (maximum age ≤ 18), the presence of OCF was detected by plain radiography in 10.1% of patients, MRI in 76.6% of patients, and CT in 89.5% of patients. For management of an OCF, the surgical options include fixation for larger pieces, excision for smaller pieces, and conservative management on a case‐by‐case basis. ConclusionsBased on the current available evidence, assessment and management of patellar dislocations and subsequent OCFs vary, with radiography and MRI as the main imaging modalities on presentation and particular benefit for MRI in the paediatric population. Findings from this study suggest the highest rate of OCF detection with MRI, and thus, surgeons should consider routinely ordering an MRI in patients with first‐time patellar dislocation. Regarding management of OCFs, the main indication for fixation was large fragments, while smaller and poor‐quality fragments are excised. Few studies choose conservative management of OCFs due to later requirements for surgical management. Future work should focus on large, high‐quality studies, and implementation of randomised control trials to form guidelines for imaging patellar dislocations and management of OCFs. Level of evidenceLevel IV.

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“…It is estimated that nearly half of a person's lifetime radiation exposure comes from medical imaging. 37 The dose-effect relation of ionizing radiation is very hard to study and therefore not clear, however, it is a well-known factor that pediatric patients are at an increasing risk because of the increased vulnerability of rapidly dividing tissues to radiation.…”

Section: Radiation Exposurementioning

confidence: 99%

The Hidden Cost of Growth-Friendly Treatment for Early Onset Scoliosis

Çetik¹,

Yazıcı²

2022

Journal of the Pediatric Orthopaedic Society of North America

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Surgical treatment of early onset scoliosis (EOS) presents unique challenges because of the long period of treatment and multiple surgical interventions. Current surgical techniques are successful in terms of deformity correction, but by looking at a wider perspective, one can see that there is much more to EOS than the radiographic deformity.Growth-friendly treatment with growing rods have the potential to result in a stiff thoracic cage, and treatment can result in significant deteriorations in the child and parents' psychosocial status not only during the treatment period, but even after the surgical treatment is over. The long-term effect of metal ion release and higher radiation exposure of patients with EOS is also an important consideration over the lifetime of the patient.The purpose of this review is to emphasize that EOS is not solely a musculoskeletal disorder but more of a systemic one. Surgical treatment may bring lifelong impacts on the patient's health, some being iatrogenic and others more of a disease-related nature. The non-spine outcomes of EOS treatment should not be overlooked. Key Concepts• Early onset scoliosis (EOS) is a systemic disorder.• Growth-friendly treatments are preferred to prevent cardiopulmonary disease; however, the positive effects on pulmonary development may be less than expected, and repetitive surgical interventions may result in a stiff thoracic cage.• Surgical stress brings a psychosocial burden on the patients which may persist into adulthood.• Persistently elevated levels of metal ions is a serious concern, with unclear long-term effects.• Increased radiation exposure in patients with EOS is still an issue despite the use of new techniques.

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Radiation Reduction Strategies in Pediatric Orthopaedics

Cited by 6 publications

References 54 publications

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

Decreasing Radiation Exposure in the Treatment of Pediatric Long Bone Fractures Using a DXA Scan: A Proof of Concept

MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

The Hidden Cost of Growth-Friendly Treatment for Early Onset Scoliosis

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