Standing Low-dose Radiation Hand Radiograph for Skeletal Maturity Assessment Significantly Reduces Time Cost, Radiation-related Risk with Maintained Excellent Reliability in Children
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AbstractIntroduction: Repeated radiation exposure to spine and hand in children during follow-up assessment in idiopathic scoliosis (IS) raised the concern about increased lifetime risk of cancer. Recently biplanar low-dose X-ray (EOS) system emerged to solve the problem. However, incorporation of routine hand radiograph procedure remained unsatisfactory. We proposed a new modified standing hand radiographs workflow taken immediately follow EOS spinal radiograph. This study aimed to determine the reliability, time cost-effectiveness, and safety of this new protocol.

Methods: This was a retrospectively review of hand radiographs with diagnosis of IS in 2016/17 interval using the EOS workflow. Tanner-Whitehouse III (TW3) staging for maturity indicators (from stage E to I) in thumb region were scored and categorised as thumb ossification composite index (TOCI) scores. Inter- and intra-rater reliability test were conducted among 6 raters. X-ray procedure timing was recorded from 30 subjects and accumulated radiation dose calculated.

Results: A total of 3600 scores of thumb epiphyses obtained from 100 hand radiographs were analysed, which showed overall intraclass coefficient (0.989, 0.997 respectively) for all TW3 maturity indicators and TOCI score among all raters. The mean (± standard deviation) time reduction was 12.5 ± 2.2 minutes per subject and 50% less radiation dose compared with conventional hand radiographs workflow.

Conclusion: The newly proposed standing low-dose radiation hand radiograph workflow improve time efficiency, safety of the procedure to children with IS. The highly reliable image quality facilitate essential skeletal maturity assessment for clinical decision making, favouring future development, and promotion of this workflow.
All Author(s) ListALH Hung, LCM Lau, A Kumar, WW Chau, TP Lam, JCY Cheng
Name of ConferenceHong Kong Orthopaedic Association 37th Annual Congress 2017
Start Date of Conference04/11/2017
End Date of Conference05/11/2017
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
Proceedings TitleThe Proceedings of the Hong Kong Orthopaedic Association 37th Annual Congress 2017
Year2017
Month11
Place of PublicationHong Kong
Pages30 - 30
LanguagesEnglish-United Kingdom

Last updated on 2018-08-06 at 13:00