Acıbadem Comprehensive Spine Center

3D visualization of scoliosis with low radiation exposure

Scoliosis and many other orthopedic conditions that were diagnosed using conventional MRI and X-ray scans in the past can now be studied on clear and detailed images that are captured using the EOS device with low-dose radiation exposure.

How is it applied?

Many conditions in the field of orthopedics and traumatology, including scoliosis, which is a 3-dimensional and very complex type of deformity, are evaluated using two-dimensional imaging modalities. Until today, 2-dimensional images from scoliosis patients were captured first from the frontal and then from the lateral plane by turning the patient sideways. Images thus obtained could only be studied in two dimensions.

Computerized tomography (CT), which is the only modality currently used to obtain 3-D images, is not useful in the assessment of scoliosis due to the high radiation exposure and because it fails to capture images in the upright position. Another reason why CT cannot be used in the assessment of scoliosis is a difference of approximately 10 to 20 degrees in spinal curvature when the patient lies down or stands upright.

The EOS device developed by the Nobel prize-winning physicist Georges Charpak captures 3-D images with a reduction in radiation exposure.

How does the EOS Device work?

EOS uses two tubes with two collimators to capture frontal and lateral images simultaneously without changing the patient's upright position. It is, therefore, not affected by changes in patient's position.

In addition, while even the most technologically advanced X-ray machines currently available in the world only provide poor quality scoliosis images, the EOS device consistently offers high-quality images from all body parts with it's whole body scan capability. This is a great convenience for physicians.

Surgeons attach great importance to image quality when managing scoliosis because the decision to use a brace or only observe the patient is based on measuring certain angles on the radiographic films. Poor image quality can make identification of landmark structures difficult. Therefore, measurements on conventional X-rays are associated with an error by +/- 5 degrees.

Clear images with less radiation

3D reconstruction is possible thanks to a special software program installed to the EOS device. The device captures two different images simultaneously in the same position and the rendered 3D image can then be studied by the surgeon. Thus, the skeletal deformity can better be evaluated. The goal in scoliosis surgery is to fuse as few vertebrae as possible while achieving the best curve correction, and thus, to maximize the range of motion of the patient. Even the smallest difference in the number of surgically fused vertebrae may have significant impact on patient's quality of life.

Potentially reduces the number of scans needed

Another benefit of the EOS device, which is used in many leading centers all around the globe, is its ability to complete the scan with very low radiation exposure. First generation EOS devices were known to reduce exposure by 5 to 10-fold. The microdose system that is used in the new generation device that has been introduced at the Acıbadem Maslak HOspital Spinal Health Center enables a dose reduction by more than 10-fold.

Based on reports from Danish experts, follow-up of scoliotic children using conventional X-ray scans is associated with an increased risk of both breast and uterine cancer. This suggests that radiation-related side effects may occur more frequently in adolescents who are scanned frequently with conventional X-rays.

Behavioral models of scoliotic spine may be created

By analyzing the 3D images of scoliotic children who have been in follow-up from a very young age, certain models of the anticipated behavior of scoliotic spine may be created. These models may enable us to predict the likelihood of progression of a particular scoliosis case.

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