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Idiopathic scoliosis in children and adolescents: assessment with a biplanar X-ray device.

Amzallag-Bellenger E, Uyttenhove F, Nectoux E, Moraux A, Bigot J, Herbaux B, Boutry N - Insights Imaging (2014)

Bottom Line: It is a three-dimensional (3D) spinal deformity.Conventional radiography is still the modality of choice for evaluation of children and adolescents with idiopathic scoliosis, but it requires repeat radiographs until skeletal maturity is reached and does not provide information about spinal deformity in all three planes.With its specific software, this novel vertical biplanar X-ray unit provides 3D images of the spine and offers the opportunity of visualising the spinal deformity in all three planes.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Radiology, Jeanne de Flandre Hospital, Lille 2 University, University Hospital of Lille, Lille, France.

ABSTRACT

Unlabelled: Idiopathic scoliosis is one of the most common conditions encountered in paediatric practice. It is a three-dimensional (3D) spinal deformity. Conventional radiography is still the modality of choice for evaluation of children and adolescents with idiopathic scoliosis, but it requires repeat radiographs until skeletal maturity is reached and does not provide information about spinal deformity in all three planes. A biplanar X-ray device is a new technique that enables standing frontal and lateral radiographs of the spine to be obtained at lowered radiation doses. With its specific software, this novel vertical biplanar X-ray unit provides 3D images of the spine and offers the opportunity of visualising the spinal deformity in all three planes. This pictorial review presents our experience with this new imaging system in children and adolescents with idiopathic scoliosis.

Key points: • The biplanar X-ray device produces two orthogonal spine X-ray images in a standing position. • The biplanar X-ray device can assess idiopathic scoliosis with a lower radiation dose. • The biplanar X-ray device provides 3D images of the spine.

No MeSH data available.


Related in: MedlinePlus

Surface 3D reconstructions of the spine in a 13-year-old girl with idiopathic thoracic scoliosis. A 3D model of the spine (indicated in red) is generated by the software and overlayed to the native AP and lateral radiographs (a). This model has to be manually adjusted by the operator to precisely match the spinal anatomy. Different perspectives of the spinal deformity are obtained, showing the right thoracic curvature, superior (T6) and inferior (T12) end vertebrae (in blue), and the apical vertebra (T8) in yellow (b). Measurements based on the 3D model are finally automatically computed, including values for spinal curvatures, axial vertebral rotation and pelvic parameters. [Total DAP = 626 mGy·cm2]
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Fig4: Surface 3D reconstructions of the spine in a 13-year-old girl with idiopathic thoracic scoliosis. A 3D model of the spine (indicated in red) is generated by the software and overlayed to the native AP and lateral radiographs (a). This model has to be manually adjusted by the operator to precisely match the spinal anatomy. Different perspectives of the spinal deformity are obtained, showing the right thoracic curvature, superior (T6) and inferior (T12) end vertebrae (in blue), and the apical vertebra (T8) in yellow (b). Measurements based on the 3D model are finally automatically computed, including values for spinal curvatures, axial vertebral rotation and pelvic parameters. [Total DAP = 626 mGy·cm2]

Mentions: Idiopathic scoliosis is characterised by a vertebral deviation in the coronal and sagittal planes but also by a vertebral rotation in the axial (or horizontal) plane. Axial vertebral rotation is difficult to assess on 2D radiographs but it may be explored with CT scans and 3D CT reconstructions [24, 25]. This technique is, however, performed in the supine position; it is limited to short spinal segments and requires a higher radiation dose than conventional or digital radiography, even at low CT doses. In contrast, the EOS system provides large size 3D images of the spine (Fig. 4) from the two lowered-dose X-rays, with no additional radiation and in standing functional position. Three-dimensional EOS images differ from CT reconstructions in that they correspond to surface reconstructions (that are not validated yet in congenital scoliosis) and not real reconstructions. These 3D images provide a better understanding of the spinal deformity from different perspectives (Fig. 4). They may be performed with and without bracing (Fig. 5) or before and after surgery (Fig. 6). Once 3D images are complete, the software automatically generates measurements related to spinal coronal (Cobb angle) and sagittal curves (thoracic kyphosis, lumbar lordosis), and to pelvic parameters. Since they have been computed from 3D space, these measurements have been shown to be more accurate, reliable and reproducible [15, 26]. In current practice, however, some difficulties may be encountered during the 3D reconstruction process. A severe curvature in the coronal plane is responsible for poor visibility of some vertebrae in the sagittal plane, making the adjustment of the model by the operator more difficult (Fig. 7). The presence of lumbosacral transitional vertebrae (i.e. sacralisation of L5 or lumbarisation of S1) is another cause of difficulty since the sterEOS 3D software is not validated yet for this type of anatomical variant (Fig. 8). In this case, the best solution for the operator is to exclude the transitional vertebra from the 3D reconstruction process.Fig. 4


Idiopathic scoliosis in children and adolescents: assessment with a biplanar X-ray device.

Amzallag-Bellenger E, Uyttenhove F, Nectoux E, Moraux A, Bigot J, Herbaux B, Boutry N - Insights Imaging (2014)

Surface 3D reconstructions of the spine in a 13-year-old girl with idiopathic thoracic scoliosis. A 3D model of the spine (indicated in red) is generated by the software and overlayed to the native AP and lateral radiographs (a). This model has to be manually adjusted by the operator to precisely match the spinal anatomy. Different perspectives of the spinal deformity are obtained, showing the right thoracic curvature, superior (T6) and inferior (T12) end vertebrae (in blue), and the apical vertebra (T8) in yellow (b). Measurements based on the 3D model are finally automatically computed, including values for spinal curvatures, axial vertebral rotation and pelvic parameters. [Total DAP = 626 mGy·cm2]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195844&req=5

Fig4: Surface 3D reconstructions of the spine in a 13-year-old girl with idiopathic thoracic scoliosis. A 3D model of the spine (indicated in red) is generated by the software and overlayed to the native AP and lateral radiographs (a). This model has to be manually adjusted by the operator to precisely match the spinal anatomy. Different perspectives of the spinal deformity are obtained, showing the right thoracic curvature, superior (T6) and inferior (T12) end vertebrae (in blue), and the apical vertebra (T8) in yellow (b). Measurements based on the 3D model are finally automatically computed, including values for spinal curvatures, axial vertebral rotation and pelvic parameters. [Total DAP = 626 mGy·cm2]
Mentions: Idiopathic scoliosis is characterised by a vertebral deviation in the coronal and sagittal planes but also by a vertebral rotation in the axial (or horizontal) plane. Axial vertebral rotation is difficult to assess on 2D radiographs but it may be explored with CT scans and 3D CT reconstructions [24, 25]. This technique is, however, performed in the supine position; it is limited to short spinal segments and requires a higher radiation dose than conventional or digital radiography, even at low CT doses. In contrast, the EOS system provides large size 3D images of the spine (Fig. 4) from the two lowered-dose X-rays, with no additional radiation and in standing functional position. Three-dimensional EOS images differ from CT reconstructions in that they correspond to surface reconstructions (that are not validated yet in congenital scoliosis) and not real reconstructions. These 3D images provide a better understanding of the spinal deformity from different perspectives (Fig. 4). They may be performed with and without bracing (Fig. 5) or before and after surgery (Fig. 6). Once 3D images are complete, the software automatically generates measurements related to spinal coronal (Cobb angle) and sagittal curves (thoracic kyphosis, lumbar lordosis), and to pelvic parameters. Since they have been computed from 3D space, these measurements have been shown to be more accurate, reliable and reproducible [15, 26]. In current practice, however, some difficulties may be encountered during the 3D reconstruction process. A severe curvature in the coronal plane is responsible for poor visibility of some vertebrae in the sagittal plane, making the adjustment of the model by the operator more difficult (Fig. 7). The presence of lumbosacral transitional vertebrae (i.e. sacralisation of L5 or lumbarisation of S1) is another cause of difficulty since the sterEOS 3D software is not validated yet for this type of anatomical variant (Fig. 8). In this case, the best solution for the operator is to exclude the transitional vertebra from the 3D reconstruction process.Fig. 4

Bottom Line: It is a three-dimensional (3D) spinal deformity.Conventional radiography is still the modality of choice for evaluation of children and adolescents with idiopathic scoliosis, but it requires repeat radiographs until skeletal maturity is reached and does not provide information about spinal deformity in all three planes.With its specific software, this novel vertical biplanar X-ray unit provides 3D images of the spine and offers the opportunity of visualising the spinal deformity in all three planes.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Radiology, Jeanne de Flandre Hospital, Lille 2 University, University Hospital of Lille, Lille, France.

ABSTRACT

Unlabelled: Idiopathic scoliosis is one of the most common conditions encountered in paediatric practice. It is a three-dimensional (3D) spinal deformity. Conventional radiography is still the modality of choice for evaluation of children and adolescents with idiopathic scoliosis, but it requires repeat radiographs until skeletal maturity is reached and does not provide information about spinal deformity in all three planes. A biplanar X-ray device is a new technique that enables standing frontal and lateral radiographs of the spine to be obtained at lowered radiation doses. With its specific software, this novel vertical biplanar X-ray unit provides 3D images of the spine and offers the opportunity of visualising the spinal deformity in all three planes. This pictorial review presents our experience with this new imaging system in children and adolescents with idiopathic scoliosis.

Key points: • The biplanar X-ray device produces two orthogonal spine X-ray images in a standing position. • The biplanar X-ray device can assess idiopathic scoliosis with a lower radiation dose. • The biplanar X-ray device provides 3D images of the spine.

No MeSH data available.


Related in: MedlinePlus