This review aims to identify strategies to optimise radiography practice using digital technologies, for full spine studies on paediatrics focusing particularly on methods used to diagnose and measure severity of spinal curvatures. The literature search was performed on different databases (PubMed, Google Scholar and ScienceDirect) and relevant websites (e.g., American College of Radiology and International Commission on Radiological Protection) to identify guidelines and recent studies focused on dose optimisation in paediatrics using digital technologies. Plain radiography was identified as the most accurate method. The American College of Radiology (ACR) and European Commission (EC) provided two guidelines that were identified as the most relevant to the subject. The ACR guidelines were updated in 2014; however these guidelines do not provide detailed guidance on technical exposure parameters. The EC guidelines are more complete but are dedicated to screen film systems. Other studies provided reviews on the several exposure parameters that should be included for optimisation, such as tube current, tube voltage and source-to-image distance; however, only explored few of these parameters and not all of them together. One publication explored all parameters together but this was for adults only. Due to lack of literature on exposure parameters for paediatrics, more research is required to guide and harmonise practice
Aim: Optimise a set of exposure factors, with the lowest effective dose, to delineate spinal curvature with the modified Cobb method in a full spine using computed radiography (CR) for a 5-year-old paediatric anthropomorphic phantom.Methods: Images were acquired by varying a set of parameters: positions (antero-posterior (AP), posteroanterior (PA) and lateral), kilo-voltage peak (kVp) (66-90), source-to-image distance (SID) (150 to 200cm), broad focus and the use of a grid (grid in/out) to analyse the impact on E and image quality(IQ). IQ was analysed applying two approaches: objective [contrast-to-noise-ratio/(CNR] and perceptual, using 5 observers. Monte-Carlo modelling was used for dose estimation. Cohen’s Kappa coefficient was used to calculate inter-observer-variability. The angle was measured using Cobb’s method on lateralprojections under different imaging conditions.Results: PA promoted the lowest effective dose (0.013 mSv) compared to AP (0.048 mSv) and lateral (0.025 mSv). The exposure parameters that allowed lower dose were 200cm SID, 90 kVp, broad focus and grid out for paediatrics using an Agfa CR system. Thirty-seven images were assessed for IQ andthirty-two were classified adequate. Cobb angle measurements varied between 16°±2.9 and 19.9°±0.9.Conclusion: Cobb angle measurements can be performed using the lowest dose with a low contrast-tonoise ratio. The variation on measurements for this was ±2.9° and this is within the range of acceptable clinical error without impact on clinical diagnosis. Further work is recommended on improvement tothe sample size and a more robust perceptual IQ assessment protocol for observers.
We report on the calibration and testing of a fiber Bragg grating (FBG)-based 2D-shape sensing strip for real-time monitoring of the position and orientation of the human spine during gait. The strip is evaluated for its use as an input for control of an exoskeleton for patients with spinal cord injury. By measuring the torsion and bending of the back, walking movements can be reconstructed. The 3D-printed strip has nine embedded fiber Bragg gratings that are located at specific places with respect to the vertebral column. Three FBGs are placed opposite to the thoracic vertebrae T6–T9, these FBGs are sensitive for measuring the bending of the spine during the gait cycle. Torsion is measured at two locations: at thoracic vertebra, T3 and at lumbar vertebra, L3. At these locations, the width of the strip is reduced to have a larger sensitivity for torsion. The strain at each FBG is measured using an interrogator. This leads to the radius of curvature and torsion as a function of time. The Frenet-Serret formulae are used to calculate the shape of the strip during the gait cycle. We have calibrated this FBG strip for curvature by bending it at known radius of different curvatures. We found a linear dependence between the strain and curvature. For torsion calibration we have rotated the strip with a stepper motor at different angles and monitored the strain. We, again, found a linear dependence with a small hysteresis. We mounted the strip on a healthy test subject and monitored their gait cycle. The FBG strip shows similar results when compared to a motion capture system based on multiple cameras. Although the fixation of the strip to a garment or on the back directly strongly influences the measured response, it does show a periodic and reproducible signal during the gait cycle.
