Improving the reliability of the thumb ossification composite index in patients with scoliosis using EOS imaging with acrylic plates.

PURPOSE: This study aimed to evaluate the use of an acrylic plate to stabilize hand positioning during EOS imaging to improve the Thumb Ossification Composite Index (TOCI) assessment in pediatric patients with idiopathic scoliosis. The goal was to implement a more efficient workflow with reduced radiation exposure, while maintaining diagnostic accuracy without relying on conventional hand radiography.

METHODS

This prospective study involved 84 patients, aged 7-13 years, divided into two groups: Group A (42 patients without acrylic plate stabilization) and Group B (42 patients with acrylic plate stabilization). Both groups underwent whole-spine imaging using the EOS system, and the reliability of EOS imaging in the evaluation of TOCI was compared with that of conventional hand radiography. Statistical analysis was used to assess inter- and intra-rater reliabilities using Cohen's weighted kappa.

RESULTS

Group A had an average inter-rater reliability of 0.826, whereas Group B showed a significantly higher reliability of 0.905 (p = 0.0127). The intra-rater reliability for Group A ranged from 0.747 to 0.748, whereas for Group B, it was 0.931 (p = 0.0017).

CONCLUSION

EOS imaging with an acrylic plate is a reliable, low-radiation alternative to traditional radiography for TOCI assessment in scoliosis management. Although further improvements are required to match conventional methods in terms of accuracy, the reduced radiation exposure offers significant benefits to pediatric patients.