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Type:
Educational Exhibit
Keywords:
Developmental disease, Congenital, Observer performance, Image manipulation / Reconstruction, Conventional radiography, Paediatric, Musculoskeletal spine
Authors:
E.-L. Gerety, J. Crawford, J. Hughes; Cambridge/UK
DOI:
10.1594/ecr2017/C-1253
Conclusion
At our tertiary referral centre,
further education is planned for the reporting of paediatric scoliosis radiographs,
with respect to accurate reporting of the side,
region,
apex and Cobb angle of the scoliosis.
Risser stage is rarely reported in our centre,
partially because the iliac crests are not always adequately included on the radiograph.
There is ongoing discussion as to whether radiologists will include Risser staging in their reports,
or whether this will be determined by the Paediatric Spinal Surgeon.
Further investigation is planned into the intra- and inter-observer variability of Cobb angle measurements.
Previous studies have found significant variation due to radiographic technique and measurement technique of 5-10 degrees suggesting significant change should only be reported if greater than 10 degrees (8).
However many of the studies were performed in the years before digital radiographs,
when angles were measured with a protractor on radiographic film.
More recent studies of Cobb angle measurement on digital radiographs have reduced intra- and inter-observer variability and various computer-assisted,
automatic and smartphone app measuring procedures have been developed (9).
In summary:
- The report of at least the first radiograph for scoliosis should include:
- Side of the curve
- Region of scoliosis
- Apex of the curve
- Cobb angle
- Developmental anomalies
- Risser stage
- Follow-up radiographs should re-measure the Cobb angle and report significant change of greater than 10o.
- It should also be reported if the patient has been imaged wearing a spinal brace.
- Following surgical fixation,
the type of fixation should be reported and complications sought.