Abstract：
OBJECTIVE: A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs.
METHODS: Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters.
RESULTS: Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05).
CONCLUSIONS: The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.
METHODS: Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters.
RESULTS: Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05).
CONCLUSIONS: The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.
摘要：
目的：青少年特发性脊柱侧凸（AIS）患者低剂量立体放射造影的手在壁（HOW）位置可以评估手和手腕的骨骼成熟度。我们的目标是双重的：使用HOWX射线照片确认骨骼成熟度评估的可靠性和有效性，并将脊柱和骨盆3D参数与标准的手在脸颊（HOC）立体放射照片的参数进行比较。
方法：70例AIS患者在同一天接受了两次连续的立体放疗和一次标准的手和腕部X光片。患者被随机分配从HOW开始，然后从HOC开始，反之亦然。评估者评估了数字骨骼年龄(DSA)，桑德斯简化骨骼成熟度(SSMS)和拇指骨化综合指数(TOCI)。对每个立体放射照相进行脊柱和骨盆骨的3D重建，以测量9个临床相关的脊柱和骨盆3D参数。
结果：DSA的评分者间和评分者间可靠性非常好，SSMS和TOCI同时具有标准X线片和HOW(ICC>0.95)。在两种成像类型的评级之间发现强相关性(ICC>0.95)。在3D重建中，后凸和骶骨斜率在HOW位置略有下降，但在临床误差范围内。所有其他参数在位置之间没有显著差异(p<0.05)。
结论：结果表明，HOW立体放射摄影允许临床医生以足够的可靠性和有效性评估手和手腕的骨骼成熟度。我们建议脊柱侧凸诊所采用HOW位置来评估骨骼成熟度，因为对脊柱和骨盆评估没有显著的临床影响。在辐射暴露方面，成本或时间。
方法：70例AIS患者在同一天接受了两次连续的立体放疗和一次标准的手和腕部X光片。患者被随机分配从HOW开始，然后从HOC开始，反之亦然。评估者评估了数字骨骼年龄(DSA)，桑德斯简化骨骼成熟度(SSMS)和拇指骨化综合指数(TOCI)。对每个立体放射照相进行脊柱和骨盆骨的3D重建，以测量9个临床相关的脊柱和骨盆3D参数。
结果：DSA的评分者间和评分者间可靠性非常好，SSMS和TOCI同时具有标准X线片和HOW(ICC>0.95)。在两种成像类型的评级之间发现强相关性(ICC>0.95)。在3D重建中，后凸和骶骨斜率在HOW位置略有下降，但在临床误差范围内。所有其他参数在位置之间没有显著差异(p<0.05)。
结论：结果表明，HOW立体放射摄影允许临床医生以足够的可靠性和有效性评估手和手腕的骨骼成熟度。我们建议脊柱侧凸诊所采用HOW位置来评估骨骼成熟度，因为对脊柱和骨盆评估没有显著的临床影响。在辐射暴露方面，成本或时间。
