Early onset scoliosis (EOS) is a complex and heterogeneous group of disorders in children under 5 years of age.
It involves a spectrum of conditions from infantile resolving scoliosis to more severe deformity that is less likely to resolve without aggressive treatment.
EOS imaging technology captures whole-body images of a standing patient in a single scan.
Frontal and lateral digital images can be obtained simultaneously and converted to a personalized 3D bone modeling of the patient in a weight-bearing position with automatic calculation of clinical parameters.
The result is a customized model of each patient to ensure tailored treatment throughout the care continuum.
Nigel J. Price, MD is here to explain what EOS is, what are the benefits, and how has it changed your pediatric orthopedic management.
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EOS and 3D Modeling
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Learn more about Nigel J. Price, MD
Nigel J. Price, MD
Nigel J. Price, MD, FAAP, FRCSC is a Pediatric Orthopaedic Surgeon with Children’s Mercy Kansas City; Chief, Section of Spine Surgery; Associate Professor of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Orthopaedic Surgery, University of Kansas; and Orthopaedics Associate Program Director, Truman Medical Center. He received his medical degree from Queen's University Kingston, Ontario, Canada, and completed residency in Orthopaedic Surgery, Queen's University/Kingston General Hospital, Kingston, Ontario, Canada. He completed fellowships in Pediatric Orthopaedic Surgery at Adelaide Women and Children's Hospital, Adelaide, Australia, & Hospital for Sick Children, Toronto, Ontario, Canada and Clinical Orthopaedics Queen's University/Kingston General Hospital, Kingston, Ontario, Canada.Learn more about Nigel J. Price, MD
Transcription:
EOS and 3D Modeling
Dr. Michael Smith (Host): Our topic today is EOS and 3D Modeling. My guest is Dr. Nigel Price. Dr. Price is the Associate Professor of Orthopedic Surgery at the University of Missouri Kansas City School of Medicine. Dr. Price, welcome to the show.
Dr. Nigel Price (Guest): Thank you for having me. Good morning.
Dr. Smith: Let’s start off with what is EOS and how common of a condition is this?
Dr. Price: Actually, EOS can apply to two different phenomenon. EOS is “early onset scoliosis”, but that is a subset of kids with curves. When we think of EOS as a technology and as a way of imaging, that is a fairly new technology that allows lower dosing of radiation. When we have the add-on the stereo software we can actually render a 3D image – a three dimensional image--of the spine. That is a tool that we are currently using for planning our surgeries and planning our care.
Dr. Smith: Let’s go a little bit more into the EOS imaging technology. How new is this? What are some of the benefits of it? Then, I’d like to also get into how has this changed pediatric orthopedic management? Let’s just start with a little bit more about that technology.
Dr. Price: The technology has been in place for over a decade and developed by a European French physicist who, I believe, actually was a Nobel Laureate as a result of this technology. Essentially, it allowed imaging in a way that we didn’t have to chop up the patient and stitch the images together. The resolution was better and also less distortion. A very happy consequence of this technology was that the amount of radiation that the patient received was less. We have acquired this imaging at our institution about a year and a half ago. It looks a little different from a conventional radiology suite in that the patient is positioned in a sitting position in a device that looks a lot like a big, tall orange closet with an opening. The tech positions them there and then is able to capture both a front view and a side view simultaneously. Many centers in North America have acquired this over the last five years and my understanding is that many are seeing the advantage of a lower radiation technology, particularly in patients who require frequent imaging, as spine patients do.
Dr. Smith: You mentioned better resolution and lower radiation. Those are huge wins across the board.
Dr. Price: They are. I’m a pediatric orthopedic surgeon and our commitment to our patients and our families is to image gently which is a phrase that is often used when children come into play. We want to reduce the amount of radiation that they require because it can have long-term effects in terms of potential for cancer. That is our commitment to our patients. This technology has allowed us to image the entire spine and the lower extremities in a way that reduces the radiation. We just acquired another add-on recently which is a special filter which reduces the amount of radiation by almost the power of ten. Instead of 1/7th of the typical, we’re now at something like 1/30th or 1/50th. It is really a nice boon to the patient care.
Dr. Smith: Dr. Price, tell us a little bit more, though. What is the result of this? At the end of the day, with imaging better, it’s safer. You’re getting a better image. What does it really mean to you as a surgeon?
Dr. Price: To me, as a surgeon, it means that I can pre-operatively plan my cases and with a nice high resolution x-ray, I can assess my patient’s spine. My day job is spine surgery. I can see the structures very well and with the additional software – the stereo component – I can actually assess that spine in three dimensions. I can, with the help of a technician who digitizes the x-rays, we can look at that spine in multiple planes. We can determine where most of the deformity is and we can plan both bracing technologies – a non-operative approach to care. But, we can also plan our surgeries in that, with the 3D images, we can concentrate our technique to maximally correct that spinal deformity. It carries into the operating room with us.
Dr. Smith: Is the imaging technology also helping in knowing which patients are going to benefit most from surgery, some that can do some of the bracing technology? Is it helping you also to make those kinds of decisions?
Dr. Price: You know, when you have a technology that has a little less radiation exposure – in this case it is substantially less – we do feel that we can optimize the interval that they come back. I think because we’re sensitive about radiation exposure, we sometimes would have them maybe come back less frequently. I think when we do the summation--when we do the math on exposure --we can kind of tailor the care in terms of how frequently they come back. Particularly in patients who are rapidly growing and their curve is growing with them, we can optimize their scrutiny and their vigilance. We feel a little less – perhaps guilty is the word – in terms of the number of radiographs there are getting. Not that we’re being cavalier about the number of films at this point, but we can optimize the intervals that they are seen so that way, we can keep tweaking their bracing, for instance, or time their surgery a little bit better.
Dr. Smith: What does the future look like for this type of imaging technology and 3D modeling?
Dr. Price: Actually, some investigators in Quebec – Dr. Parent and his group and others – have collaborated with this technology and they have brought us into a whole new era of assessing the spine and stratifying risks. So, in other words, based on the 3D modelling and the classification we can now – eventually, hopefully – determine the risk of progression so that if we have a sense as to how likely it is for that patient’s curve to get worse, we can then tailor their treatment, tailor their follow up. So, some children, for instance, historically, would have just kept coming back every four to six months for x-rays. Now, if we stratify their risk as low, they don’t have to come back as frequently for radiographs; whereas, in another group who are of a high risk of progression, we can perhaps see them more frequently and not have a greater risk of missing their curve progression. Since we don’t really have a great handle on why kids, why most of the idiopathic patients are getting their curves, we don’t really have a medical intervention, so we have to consider bracing and/or surgery. We can, hopefully, keep a lot of those kids out of the operating room if we can successfully non-operatively treat them.
Dr. Smith: Dr. Price, thank you for the work that you’re doing and thanks for coming on this show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.
EOS and 3D Modeling
Dr. Michael Smith (Host): Our topic today is EOS and 3D Modeling. My guest is Dr. Nigel Price. Dr. Price is the Associate Professor of Orthopedic Surgery at the University of Missouri Kansas City School of Medicine. Dr. Price, welcome to the show.
Dr. Nigel Price (Guest): Thank you for having me. Good morning.
Dr. Smith: Let’s start off with what is EOS and how common of a condition is this?
Dr. Price: Actually, EOS can apply to two different phenomenon. EOS is “early onset scoliosis”, but that is a subset of kids with curves. When we think of EOS as a technology and as a way of imaging, that is a fairly new technology that allows lower dosing of radiation. When we have the add-on the stereo software we can actually render a 3D image – a three dimensional image--of the spine. That is a tool that we are currently using for planning our surgeries and planning our care.
Dr. Smith: Let’s go a little bit more into the EOS imaging technology. How new is this? What are some of the benefits of it? Then, I’d like to also get into how has this changed pediatric orthopedic management? Let’s just start with a little bit more about that technology.
Dr. Price: The technology has been in place for over a decade and developed by a European French physicist who, I believe, actually was a Nobel Laureate as a result of this technology. Essentially, it allowed imaging in a way that we didn’t have to chop up the patient and stitch the images together. The resolution was better and also less distortion. A very happy consequence of this technology was that the amount of radiation that the patient received was less. We have acquired this imaging at our institution about a year and a half ago. It looks a little different from a conventional radiology suite in that the patient is positioned in a sitting position in a device that looks a lot like a big, tall orange closet with an opening. The tech positions them there and then is able to capture both a front view and a side view simultaneously. Many centers in North America have acquired this over the last five years and my understanding is that many are seeing the advantage of a lower radiation technology, particularly in patients who require frequent imaging, as spine patients do.
Dr. Smith: You mentioned better resolution and lower radiation. Those are huge wins across the board.
Dr. Price: They are. I’m a pediatric orthopedic surgeon and our commitment to our patients and our families is to image gently which is a phrase that is often used when children come into play. We want to reduce the amount of radiation that they require because it can have long-term effects in terms of potential for cancer. That is our commitment to our patients. This technology has allowed us to image the entire spine and the lower extremities in a way that reduces the radiation. We just acquired another add-on recently which is a special filter which reduces the amount of radiation by almost the power of ten. Instead of 1/7th of the typical, we’re now at something like 1/30th or 1/50th. It is really a nice boon to the patient care.
Dr. Smith: Dr. Price, tell us a little bit more, though. What is the result of this? At the end of the day, with imaging better, it’s safer. You’re getting a better image. What does it really mean to you as a surgeon?
Dr. Price: To me, as a surgeon, it means that I can pre-operatively plan my cases and with a nice high resolution x-ray, I can assess my patient’s spine. My day job is spine surgery. I can see the structures very well and with the additional software – the stereo component – I can actually assess that spine in three dimensions. I can, with the help of a technician who digitizes the x-rays, we can look at that spine in multiple planes. We can determine where most of the deformity is and we can plan both bracing technologies – a non-operative approach to care. But, we can also plan our surgeries in that, with the 3D images, we can concentrate our technique to maximally correct that spinal deformity. It carries into the operating room with us.
Dr. Smith: Is the imaging technology also helping in knowing which patients are going to benefit most from surgery, some that can do some of the bracing technology? Is it helping you also to make those kinds of decisions?
Dr. Price: You know, when you have a technology that has a little less radiation exposure – in this case it is substantially less – we do feel that we can optimize the interval that they come back. I think because we’re sensitive about radiation exposure, we sometimes would have them maybe come back less frequently. I think when we do the summation--when we do the math on exposure --we can kind of tailor the care in terms of how frequently they come back. Particularly in patients who are rapidly growing and their curve is growing with them, we can optimize their scrutiny and their vigilance. We feel a little less – perhaps guilty is the word – in terms of the number of radiographs there are getting. Not that we’re being cavalier about the number of films at this point, but we can optimize the intervals that they are seen so that way, we can keep tweaking their bracing, for instance, or time their surgery a little bit better.
Dr. Smith: What does the future look like for this type of imaging technology and 3D modeling?
Dr. Price: Actually, some investigators in Quebec – Dr. Parent and his group and others – have collaborated with this technology and they have brought us into a whole new era of assessing the spine and stratifying risks. So, in other words, based on the 3D modelling and the classification we can now – eventually, hopefully – determine the risk of progression so that if we have a sense as to how likely it is for that patient’s curve to get worse, we can then tailor their treatment, tailor their follow up. So, some children, for instance, historically, would have just kept coming back every four to six months for x-rays. Now, if we stratify their risk as low, they don’t have to come back as frequently for radiographs; whereas, in another group who are of a high risk of progression, we can perhaps see them more frequently and not have a greater risk of missing their curve progression. Since we don’t really have a great handle on why kids, why most of the idiopathic patients are getting their curves, we don’t really have a medical intervention, so we have to consider bracing and/or surgery. We can, hopefully, keep a lot of those kids out of the operating room if we can successfully non-operatively treat them.
Dr. Smith: Dr. Price, thank you for the work that you’re doing and thanks for coming on this show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.