Could Ultrasound Curve Angle (UCA) Measurement Reduce Unnecessary X-Ray Exposure for Screening Scoliosis Among Schoolchildren? – A Study of 509 Skeletally Immature Female Subjects
Invited conference paper presented and published in conference proceedings
CUHK Authors
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AbstractIntroduction: Radiation-free scoliosis screening is an important area under development to reduce children’s cumulative exposure to ionizing radiation. Previous studies have suggested Spinous Process Angle (SPA) measured by ultrasound (US) may have lower accuracy for mild curve in skeletally-immature patients due to smaller body build and short stature. A new model of measurement, the Ultrasound Curve Angle (UCA) has been proposed as a potential replacement for SPA.
Objectives: The aim of our study is to: a) evaluate the application of ultrasound (SPA vs UCA method) in determining referral status for x-ray radiographs in a primary cohort of 414 skeletallyimmature AIS girls; b) validate and compare the sensitivity and specificity of UCA vs SPA in a validation cohort of 95 AIS girls.
Methods: Hong Kong has a well-established 2-tier scoliosis screening program where children at Grade 5 with a positive forward bending test and ATR 5-14° will receive Moire-Topography, to determine the need for X-ray radiographs to confirm diagnosis of scoliosis. 414 girls aged 10-14yo with menarche status ≤9months and recommended for x-ray investigation in the scoliosis-screening workflow were recruited in 2018-2020. Another cohort of 95 AIS girls were recruited for validation between 2021-2023. All EOS x-rays were taken within 4 weeks of ultrasound measurements, using a similar standing position for both modalities. The EOS Cobb angle was measured by experienced blinded Orthopaedic specialists and the US by standardized validated method with Scolioscan system.
Results: In the primary cohort of 414 girls (age 11.8+/-1.1, Cobb 14.1+/-6.7°), the ROC-AUC for using US to predict EOS-Cobb≥20° was 0.70 for SPA, and 0.88 for UCA. In the validation cohort of 95 girls (age 12.2+/-1.0, Cobb 14.7+/-7.0°), the ROC-AUC for using US to predict EOSCobb≥20° was 0.78 for SPA, and 0.89 for UCA. The results indicated that UCA method had better performance in predicting EOS-Cobb≥20° (the referral criteria to Tertiary scoliosis center) than SPA, with a sensitivity of 0.94 and specificity of 0.59 in primary cohort (sensitivity 0.96, specificity 0.56 in the validation cohort).
Discussion: This study provided evidence that the UCA method could potentially reduce unnecessary radiation exposure from X-ray in 41-44% of subjects with satisfactory specificity and high sensitivity. The strengths of the study are its relatively large sample size of early mild AIS patients and inclusion of a validation cohort. Further technological improvements in US are desirable before routine clinical application for scoliosis screening.
Objectives: The aim of our study is to: a) evaluate the application of ultrasound (SPA vs UCA method) in determining referral status for x-ray radiographs in a primary cohort of 414 skeletallyimmature AIS girls; b) validate and compare the sensitivity and specificity of UCA vs SPA in a validation cohort of 95 AIS girls.
Methods: Hong Kong has a well-established 2-tier scoliosis screening program where children at Grade 5 with a positive forward bending test and ATR 5-14° will receive Moire-Topography, to determine the need for X-ray radiographs to confirm diagnosis of scoliosis. 414 girls aged 10-14yo with menarche status ≤9months and recommended for x-ray investigation in the scoliosis-screening workflow were recruited in 2018-2020. Another cohort of 95 AIS girls were recruited for validation between 2021-2023. All EOS x-rays were taken within 4 weeks of ultrasound measurements, using a similar standing position for both modalities. The EOS Cobb angle was measured by experienced blinded Orthopaedic specialists and the US by standardized validated method with Scolioscan system.
Results: In the primary cohort of 414 girls (age 11.8+/-1.1, Cobb 14.1+/-6.7°), the ROC-AUC for using US to predict EOS-Cobb≥20° was 0.70 for SPA, and 0.88 for UCA. In the validation cohort of 95 girls (age 12.2+/-1.0, Cobb 14.7+/-7.0°), the ROC-AUC for using US to predict EOSCobb≥20° was 0.78 for SPA, and 0.89 for UCA. The results indicated that UCA method had better performance in predicting EOS-Cobb≥20° (the referral criteria to Tertiary scoliosis center) than SPA, with a sensitivity of 0.94 and specificity of 0.59 in primary cohort (sensitivity 0.96, specificity 0.56 in the validation cohort).
Discussion: This study provided evidence that the UCA method could potentially reduce unnecessary radiation exposure from X-ray in 41-44% of subjects with satisfactory specificity and high sensitivity. The strengths of the study are its relatively large sample size of early mild AIS patients and inclusion of a validation cohort. Further technological improvements in US are desirable before routine clinical application for scoliosis screening.
All Author(s) ListLau AYC, Yang KG, Hung ALH, Lee WYW, Chu WCW, Lai KKL, Chung TWH, Lee TTY, Zhong YP, Cheng JCY, Lam TP
Name of ConferenceInternational Research Society of Spinal Deformities Scientific Meeting 2024
Start Date of Conference21/06/2024
End Date of Conference23/06/2024
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
Year2024
LanguagesEnglish-United Kingdom
