The EOS 3D imaging system reliably measures posterior tibial slope

Background One of the values determined during the assessment of knee issues is the posterior tibial slope (PTS). A new option for measuring the PTS is the EOS 3D imaging system, which provides anteroposterior (AP) and lateral long leg radiographs (LLRs) using less radiation than a conventional LLR. We investigated the reliability of the EOS 3D imaging system with respect to PTS measurements. Methods We retrospectively searched our radiological database for patients who underwent an EOS scan and a computed tomography (CT) scan of their lower extremities between January and December 2019. Fifty-six knees were included in the study. Medial and lateral PTSs were determined using both modalities. A radiologist and an orthopaedic surgeon each performed all measurements twice and the intraclass correlation (ICC) was calculated to assess inter- and intrarater reliability. The Student t test and Pearson correlation were used to compare the results of both imaging modalities. Results The mean medial PTS was 8.5° (95% confidence interval [CI], 8.1–8.9°) for the EOS system and 7.7° (95% CI, 7.3–8.1°) for CT, and the lateral PTS was 7.4° (95% CI, 6.9–7.9°) for the EOS system, and 7.0° (95% CI, 6.5–7.4°) for CT. Interrater reliability (ICC) with respect to medial and lateral PTSs measured on the EOS (0.880, 0.765) and CT (0.884, 0.887) images was excellent. The intrarater reliability of reader 1 (ICC range, 0.889–0.986) and reader 2 (ICC range, 0.868–0.980) with respect to the same measurements was excellent. Conclusion The PTS measurements from the EOS 3D imaging system are as reliable and reproducible as those from CT, the current gold standard method. We recommend using this system if possible, because it acquires more information (sagittal plane) in a scan than a conventional LLR, while exposing the patient to less radiation. Level of evidence Level III, Retrospective cohort study

Pelvic Rotation and Inclination Affect Reliability of Sagittal Pelvic Alignment and Anterior Pelvic Plane Angle Measured by EOS System

The Difficulties to obtain acceptable pelvic reference points on bi- planar X-ray images for EOS measurements change as the patient’s pelvis rotated or inclined. The aim of this study was to clarify the effects of pelvic Z-axis rotation (rotation) and X-axis rotation (inclination) on the measurement values of SS, PT, and APP angle by using of EOS. Methods: We obtained anteroposterior and lateral X-ray images of a trunk phantom which was rotated and inclined in standing position by using of the EOS. Sacral slope (SS) and pelvic tilt (PT) as parameters to judge patient’s pelvic alignments by spinal surgeons, and anterior pelvic (APP) angle as a reference to decide patient’s pelvic alignments by hip surgeons were measured with the EOS software. The values of SS and PT and APP angle were compared in the phantom rotation and inclination. Results: PT showed small changes when the phantom was rotated, however, SS decreased and APP angle increased when the phantom was rotated. The values of SS and PT dispersed at 300 rotation among each inclination. APP angle dispersed at -15o and 30o of rotation among each inclination. Conclusion: Measurement variations of SS and PT were small amount under 15 degrees of rotation and inclination. On the contrary, APP angles showed greater variations when the phantom was rotated and inclined. Proper positioning of subjects, by reducing rotational effects, is important to get constant reproducible measurements, even if we use EOS system.