New scan technology gives lower radiation dose for children with scoliosis


    Children with a curvature of the spine need regular monitoring as they reach the end of their growth period, so doctors can treat them with whatever method will keep the condition from getting worse. Children’s Hospital of Pittsburgh of UPMC and Allegheny Health Network doctors are now watching their progress with a device that exposes boys and girls to about a tenth of the radiation of traditional X-rays.

    It looks like a transporter from “Star Trek,” but the EOS device gives young patients a safer trip in treatment for their spine, hip and leg disorders, said Sheila G. Moore, clinical director of pediatric radiology at Children’s. The first patient at Children’s was scanned on Jan. 9.

    Allegheny Health Network got its EOS unit up and running in December at its new Pediatric Orthopaedic Institute in Pine, according to orthopedic surgeon Mark J. Sangimino. Images taken on several planes through the body build a three-dimensional model of the bones and joints of the spine and lower extremities.

    Both reduced radiation exposure and the 3-D imaging are important advantages of the new technology, said W. Timothy Ward, chief of the division of pediatric orthopedic surgery at Children’s.

    “Radiation exposure is a potential issue,” Dr. Ward said. “Many get a lot of X-rays over a period of time. We can’t say anyone has been hurt. But everything is cumulative. EOS allows us to dramatically cut down on exposure. It’s a great advance. … It gives a 3-D image that is helpful when planning surgical approaches.”

    Surgeons use the 3-D model to detect and place rods, hooks and screws that help to straighten the spine in severe cases.

    The device, which cost $680,000, can scan the whole body. Total cost of the installation approached $1 million, Dr. Ward said, but he anticipates the EOS being used in various orthopedic areas and offered for patients now treated at UPMC satellite centers.

    Dr. Sangimino agreed the advantages are twofold: “We have wonderful resolution. … The machine provides increased information, better resolution at a lower dose.”

    “The patients love it,” said Helen Bradley, lead diagnostic radiology technologist at Children’s. “The patients are less frightened, don’t seem to mind being closed in. They see the light going up and down.”

    Parents can sit nearby, and instead of bulky X-ray technology, the children walk into the booth-like unit and — standing — they can be scanned in both a frontal and a side view. At first, there’s a loud noise, red lights line up a crosshairs, then the scan emits a green beam of light from the top cervical vertebrae to the base of the spine, the sacrum.

    Those who have difficulty standing because of surgery or other reasons appreciate that it’s fast — 5 seconds to do the whole scan.

    Both health systems anticipate the arrival of a new chair that will allow upright screening of children who can’t stand.

    Treating scoliosis
    Scoliosis can be caused by cerebral palsy and muscular dystrophy, but the National Institutes of Health reports the most common type is idiopathic scoliosis, meaning the cause is unknown. The condition affects about 2 to 3 percent of the population and is often found in children ages 10 to 12 and also in their early teens. Girls are more likely than boys to have it.

    In mild cases children may need checkups every four to six months to see if there have been spinal changes. A brace may be recommended, and surgery may be needed to control or straighten out severe cases.

    Spine fusion surgery uses metal rods, hooks, screws or wires to hold the spine straight as the bones grow together. Sometimes a rod is attached to the top and bottom sections of the spinal curvature and is lengthened every six months.

    Safety for growing children
    Dr. Sangimino said the EOS technology can help doctors treat children with a variety of problems involving the neurological, muscular and skeletal systems.

    Last week, he said, “On Wednesday we had 11 kids, with scoliosis, limb-length inequality and spinal pelvic imbalance.” With EOS, they’re screened “to try to help build braces that are more effective, therapies that are more effective.”

    For example, he said, a 3-year-old with a curvature of the spine will first have to be scanned with a higher dose to get a high-resolution picture of the bones. But once that is determined, he said, “You don’t need a higher resolution. We can lower the dose and modify the dose.”

    There might be two or three scans needed each year to monitor the child’s growth. When needed, ultrasound technology and standard X-rays are still used.

    Radiation exposure for scoliosis patients varies, Dr. Moore said, depending on the method.

    Putting EOS to use
    “We’re very quickly seeing the advantages,” Dr. Ward said, adding that Children’s is starting a spinal deformity center that will offer low radiation imaging, bracing experts and physical therapists all in one place, designed to draw young patients from UPMC satellite centers as well.

    Prevention of severe scoliosis is the focus of the AHN practice, Dr. Sangimino said, “We’re doing better therapy, doing better interventions. We’re able to control a lot of curves we couldn’t control before.” EOS technology helps determine when simple therapy routines are most effective and helps brace makers with their work, he said.

    Among children with cerebral palsy, spina bifida and other conditions, he said EOS can deal with the multiple systems involved; sometimes there are hip dislocations. The EOS scans allow doctors to see inside joints as a young patient is standing, and mechanical problems can be diagnosed, even with girls who have a problem with dislocated kneecaps, for example. “We can use tricks to keep them out of the surgery unit,” Dr. Sangimino said.

    “My goal is to put myself out of business as a surgeon. It’s hard in today’s medicine to do that,” he said. “This is a wonderful thing.”