Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study
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AbstractPurpose
The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation.

Methods
EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach’s alpha values.

Results
In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system.

Conclusion
With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department.

Level of evidence
III
Acceptance Date05/07/2019
All Author(s) ListL. C. M. Lau, A. L. H. Hung, W. W. Chau, Z. Hu, A. Kumar, T. P. Lam, W. C. W. Chu, J. C. Y. Cheng
Journal nameJournal of Children's Orthopaedics
Year2019
Month8
Volume Number13
Issue Number4
PublisherBritish Editorial Society of Bone and Joint Surgery: Open Access / British Editorial Society of Bone & Joint Surgery
Pages385 - 392
ISSN1863-2521
eISSN1863-2548
LanguagesEnglish-United Kingdom
Keywordsadolescent idiopathic scoliosis, skeletal maturity, EOS, Tanner-Whitehouse, Thumb Ossification Composite Index, hand radiograp

Last updated on 2020-03-04 at 00:03