Fujifilm’s FDR D-EVO GL Enables Low Dose Scoliosis Screening in Children in Yale School of Medicine Study

AUTHOR: Rob Fabrizio

Scoliosis, an abnormal lateral curvature of the spine, is most often diagnosed in children  aged 11 and older.1 It can accompany certain neuromuscular conditions like cerebral  palsy or muscular dystrophy, but more than 80% of cases are idiopathic – of unknown  causes – and likely result from a combination of genetic factors and hormonal  dysregulation, among others.2

Most scoliosis cases are mild and present no clinical symptoms or pain,3 but some curves can worsen as children grow.4 Severe scoliosis can be associated with adverse health outcomes both in childhood and later in life, including impaired lung and heart function,5,6 emphasizing the importance of timely diagnosis, treatment, and management. Children who have mild scoliosis are therefore monitored closely – typically with routine X-rays – to evaluate curvature development and determine whether a treatment plan is needed and, when in place, effective.

Scoliosis progression can be unpredictable, and patients receive routine screening that can range from 10-25 to as many as 40-50 radiographs over their care history, depending on the severity of the curve.7 Initial diagnosis calls for higher radiation to allow for visualization of bone structure details, whereas follow-up assessments monitor spine curvature and skeletal maturity and can be achieved at lower doses. Nevertheless, repeat radiography using conventional systems has raised concerns about radiation exposure,8
particularly in children and adolescents, where it has been linked to increased cancer risk.9

Although a new, dedicated “ultra-low dose” radiation system – EOS dual planar scanning – exists and is thought to significantly lower the risk of cancer in children (particularly girls),10 it has major disadvantages over conventional systems. The EOS is considerably larger and more expensive, it is slower in image acquisition (and therefore more prone to motion artifacts), and it requires that patients stand or sit by themselves without external help from guardians or staff, making it less suitable for use in younger or developmentally delayed patients.

To overcome these hurdles, a team at Yale School of Medicine created an imaging protocol for follow-up scoliosis X-rays using a modified technique11 that tailors exposure to the patient’s height and weight. In addition, it uses conventional imaging equipment in combination with Fujifilm’s FDR D-EVO GL detector and Virtual GridTM anti-scatter image processing software.12 The protocol was validated by comparing images from 40 pediatric patients obtained using either the standard technique or the modified technique. Their results show that the modified technique allows for a 74% reduction in the effective dose, indicating that the incorporation of Fujifilm technology allows conventional radiographic equipment to achieve the very impressive low dose levels of the EOS system.

This new lower-dose protocol is currently used at the researchers’ institution for all follow up imaging of scoliosis patients, further attesting to its impact and perceived efficacy among medical providers. A commentary published in a recent issue of Pediatric Radiology highlights the study’s findings, indicating that their use of height- and weight optimization and replacement of physical anti-scatter grids with denoising software like Fujifilm’s Virtual GridTM are achievable changes that can help reduce radiation exposure not only in scoliosis examinations but also in other examinations.13

The full study conducted by the Yale School of Medicine may be viewed and purchased from the Pediatric Radiology journal’s website here. To learn more about the long-length single exposure detector used in the study or Fujifilm’s latest lightweight, wireless model, visit the product pages for the FDR D-EVO GL and FDR D-EVO III G80i here.





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12 Al-Dasuqi K, Taylor E, Ehrlich L, Cooperman D, Socci A, Tuason D, Hoerner M, Staib L, Silva CT. 2024. Performance and reliability assessment of a lower dose, task-based scoliosis radiography protocol in pediatric patients. Pediatr Radiol 54(1):146-153, PMID: 38010426.

13 Don S, Moore QT, Hensley P. 2024. Commentary: Achieving ALARA in scoliosis examinations by using body measurements to set techniques and eliminating physical anti-scatter grids. Pediatr Radiol 54(1):154-156, PMID: 38047922.