HSS to test use of 3D maps of spine for scoliosis treatment

New imaging technology may assist clinicians by creating three-dimensional maps of the spine to treat patients with scoliosis.

Researchers at Hospital for Special Surgery in New York are enrolling patients in a study that will test the use of a highly accurate camera that uses a 3D surface imaging system.

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The approach may be able to spare patients from overexposure to typical radiological imaging. Currently, patients with scoliosis—an excessive curvature of the spine—are assessed via X-ray imaging, typically for a period of many years. Such extensive exposure to radiation can be harmful, particularly because the condition primarily affects youths.

Researchers at the facility hope the study will lead to the development of an algorithm to estimate the curvature of the spine without needing multiple X-ray imaging exams.

The surface imaging system is from 3dMB, using technology that acquires the patient’s shape using stereophotogrammetry.

"You can take that image, flip it upside down, slice it and dice it at any level that you want because it's a mathematical depiction of the surface of the patient," contends Roger F. Widmann, MD, chief of the pediatric orthopedic surgery service at HSS.

The study combines two recently available imaging technologies—topographical mapping using 3dMD, a proprietary system of high-resolution cameras, and EOS imaging, a dual plane X-ray machine that determines spinal alignment while reducing exposure to ionizing radiation.

The 3dMD system combines information from 30 high-definition cameras to produce a full map of the torso in under a second. The speed of the process is a significant advantage over conventional imaging, according to Dr. Hillstrom, who noted that up to 10 to 20 percent of torso x-rays must be redone because inadvertent movements during the scans distort the picture.

"This technology is essentially producing the world's most advanced selfie, and the benefit is that there's nothing dangerous about it," contends Howard Hillstrom, director of the Leon Root, MD Motion Analysis Laboratory at HSS and the principal investigator of the study.

Although patients with mild and moderate cases of scoliosis can improve with physical therapy and bracing, severe cases may require surgery. "Severe scoliosis starts to affect the symmetry of the thoracic cavity and might then affect lung function," Hillstrom says.

Restoring symmetry is a primary goal of scoliosis surgery, Widmann adds. However, symmetry is difficult to determine using X-rays, which don't necessarily reveal how changes to the skeleton affect the shape of the body. "This technology is showing you the surface, and we hope it will help us align the goals of surgery even more closely with what patients and families want from the procedure." Anatomical mapping could improve bracing therapy in the same way, he added.

"Being able to use this technology to screen patients for scoliosis would be a big improvement over the current method, which uses a carpenter's level on a patient's back and has a very high rate of false-positives," Widmann says.

Many children initially suspected of having scoliosis don't have the condition—but doctors don't know that until they take an X-ray. "You're taking X-rays on a lot of kids who don't need them, so we need a very reliable technology that correlates with X-rays so that you can safely decide if you need one or not."

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