Sequential Spine-Hand Radiography for Assessing Skeletal Maturity in AIS with Low Radiation Dual-Beam Imaging System: A Feasibility and Reliability Study
Refereed conference paper presented and published in conference proceedings

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Low radiation dual-beam imaging system for spinal radiography is widely adopted for scoliosis follow-up but its role in skeletal maturity assessment is uncertain. The sequential Spine-Hand radiography workflow proposed was feasible with excellent reliability for all hand radiograph imaging, subjected to multicenter validation with larger sample sizes.
We hypothesized that the image quality of the low dose hand radiograph can allow reliably assessment of skeletal maturity in AIS patients.
Retrospective cross-sectional study
Low radiation dual-beam imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the whole spine in erect position with relatively low radiation. Skeletal maturity assessment using hand radiograph is an essential adjunct to spinal radiography in scoliosis follow up. The former was taken conventionally using digital radiography system. A new workflow was proposed in this study with aim of incorporating hand radiography immediately after spinal imaging within the same imaging setting.
Hand radiographs from patients with clinical diagnosis of idiopathic scoliosis, including both sexes and age range of 10-14 years old, were retrospectively reviewed and scored by five raters using both conventional Tanner-Whitehouse (TW3) staging over thumb epiphyses and validated Thumb Ossification Composite Index (TOCI) methods. Intraclass correlation coefficients (ICCs) were calculated for interobserver agreement and intraobserver test-retest reliability was
tested by Cronbach’s alpha values.
Sixty hand radiographs were selected randomly from all new subjects with diagnosis of AIS, including 32 males (mean age 11.53, range 10- 14), and 28 females (mean age 11.50, range 10-13) who underwent sequential spine-hand low dose imaging with a total of 600 TW3 staging scores were generated for analysis. The overall inter-observer (ICC = 0.997) and intra-observer agreement (α > 0.9) demonstrated excellent agreement for all TW3 and TOCI staging.
The proposed new sequential Spine-Hand radiography with low dose workflow was feasible to produce high image quality of hand radiography that allows skeletal maturity assessment with excellent reliability. The overall efficiency and throughput of the radiology department can thus be enhanced. Further validation on larger samples and across different centers would be helpful.
All Author(s) ListLik Hang Alec Hung, Lawrence CM Lau, Zongshan Hu, Wai-wang Chau, Simon Chow, Anubrat Kumar, Tsz-Ping Lam, Bobby Kinwah Ng, Winnie Chu, Jack C.Y. Cheng
Name of Conference25th International Meeting on Advanced Spine Techniques (IMAST)
Start Date of Conference11/07/2018
End Date of Conference14/07/2018
Place of ConferenceLos Angeles, CA
Country/Region of ConferenceUnited States of America
Proceedings TitleThe Proceeding of 25th International Meeting on Advanced Spine Techniques (IMAST)
Pages96 - 96
LanguagesEnglish-United Kingdom

Last updated on 2018-06-12 at 10:25