Shriners for Children Medical Center, 909 South Fair Oaks Ave, Pasadena, CA, 91105, USA.
Children's Hospital New Orleans, 200 Henry Clay Ave, New Orleans, LA, USA.
Spine Deform. 2021 Sep;9(5):1333-1339. doi: 10.1007/s43390-021-00324-4. Epub 2021 Mar 16.
Decreasing radiation exposure is important for scoliosis patients who require serial imaging. Microdose protocol stereoradiography is now increasingly utilized. Previous studies have reported similar reliability of concurrent Sanders skeletal maturity staging based on standard low-dose stereoradiography and standard hand radiographs. The purpose of our study was to investigate the reliability and radiation exposure of concurrent Sanders staging using microdose protocol compared to a standard protocol for adolescent idiopathic scoliosis. We hypothesized that surgeon-performed Sanders staging would have similar reliability when comparing microdose and standard-dose imaging protocols.
A randomized survey of 30 hand images using standard protocol spinal stereoradiography and an equal number from microdose protocol were distributed to six experienced pediatric orthopaedic spine surgeons. Images were graded by each surgeon according to the Sanders skeletal maturity grading system. Items were again randomized and graded after a 2-week interval. Fleiss' weighted kappa for inter and intraobserver reliability was calculated and an unpaired t test was used to test for significance.
Interobserver reliability for all modalities was in the strong to almost perfect agreement (average weighted κ > 0.8) range. For the microdose protocol, κ was 0.82 and 0.84 for each separate round of grading. Standard low-dose protocol κ was 0.83 and 0.79. Intraobserver κ was 0.86 for microdose and 0.82 for standard. Average radiation for microdose was significantly less radiation (82.6%) than standard stereoradiography (0.3 ± 0.1 mGy vs. 1.9 ± 0.4 mGy, p < 0.001).
Sanders staging reliability of a well-positioned hand during scoliosis stereoradiography was similarly excellent for both microdose and standard low-dose protocol. Microdose protocol used less radiation while still preserving the reliability of Sanders staging.
对于需要连续成像的脊柱侧弯患者，降低辐射暴露量非常重要。微剂量协议立体摄影术现在越来越多地被使用。先前的研究已经报道了基于标准低剂量立体摄影术和标准手部射线照相术的同时 Sanders 骨骼成熟分期的相似可靠性。本研究的目的是调查微剂量协议与青少年特发性脊柱侧弯的标准协议相比，同时 Sanders 分期的可靠性和辐射暴露量。我们假设，比较微剂量和标准剂量成像方案时，外科医生执行的 Sanders 分期具有相似的可靠性。
使用标准方案脊柱立体摄影术对 30 张手部图像进行随机调查，并对微剂量方案中的相同数量的手部图像进行随机分配。每位外科医生根据 Sanders 骨骼成熟分级系统对图像进行分级。在 2 周间隔后，再次对项目进行随机分级。计算 Fleiss 加权κ 以评估组内和组间的可靠性，并使用未配对 t 检验检验显著性。
所有模式的观察者间可靠性均处于强至几乎完美一致（平均加权κ＞0.8）范围。对于微剂量方案，每次单独分级的κ值分别为 0.82 和 0.84。标准低剂量方案的κ值分别为 0.83 和 0.79。微剂量的观察者内κ值为 0.86，标准为 0.82。微剂量的平均辐射量明显低于标准立体射线照相术（82.6%比 1.9±0.4 mGy，p＜0.001）。
在脊柱侧弯立体摄影术中，手部位置良好时 Sanders 分期的可靠性对于微剂量和标准低剂量方案同样出色。微剂量方案使用的辐射量较少，同时仍保留 Sanders 分期的可靠性。
