EOS: Shedding light on novel radiology

EOS: Shedding light on novel radiology

What if we could view the human body without overexposing it to harmful X-rays? Here is the short story of a success that has revolutionized the world of radiology
September 24, 2008
Dr. de Guise in front of the EOS system
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Dr. de Guise in front of the EOS system
ETS

Excerpted with permission from l'École de Technologie Supérieure (ÉTS).

Montreal, CHU Sainte-Justine, July 23, 2008. Today is a good day for young patients awaiting treatment for spinal malformations at Sainte-Justine’s. EOS III, a new low-dose 3D imaging device developed by a transatlantic team of researchers from Quebec and France, is officially up and running. But perhaps no one is more delighted than the Quebec leader of the team, Professor Jacques de Guise, director of the Laboratory on Imaging and Orthopedics research (LIO) at École de Technologie Supérieure (ÉTS) in Montreal, affiliated with the Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM).

Too much radiation

Patients suffering from bone disease such as scoliosis, a spinal deviation, require several X-rays as part of their diagnosis and treatment. In planning how best to intervene, doctors need a 3D reconstruction of the spine which demands, with standard tools like CT-scans, multiple radiographic images — images that lead inevitably to X-ray exposure.

A 3D reconstruction of the entire human body
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A 3D reconstruction of the entire human body
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“X-rays can increase the risk of developing cancer up to one in a thousand,” explains surgeon and researcher Dr. Hubert Labelle of the Centre Hospitalier Universitaire (CHU) Sainte-Justine, Mother and Child University Hospital Center.

Two countries, one technological breakthrough

A France–Quebec team was formed in the mid-1990s, driven by the desire to reduce patient exposure to X-rays. Quebec’s LIO joined with the Laboratoire de Biomécanique of the school Arts et Métiers ParisTech (led by Dr. Wafa Skalli) and company Biospace Med in France to develop algorithms for creating a complete 3D computer reconstruction of the spine, pelvis and lower limbs using only two 2D radiographs.

Another French scientist was instrumental to the development of the EOS technology. Georges Charpak earned the 1992 Nobel Prize in Physics for proposing a novel hypersensitive detection technique of elementary particles. By matching 3D reconstruction and image processing algorithms with Charpak’s technique, researchers created a first low-dose biplan radiographic system dubbed “EOS.”

The EOS system in use
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The EOS system in use
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A first prototype was introduced at Saint-Vincent-de-Paul hospital in Paris in 2002 to conduct patient trials. To pursue development and carry out their own experiments, the Quebec research team led by Jacques de Guise acquired three EOS prototypes through a grant from the Canada Foundation for Innovation. A trial prototype was first installed at ÉTS, then two clinical prototypes in 2006, one at Notre-Dame hospital of CHUM, the other at CHU Sainte-Justine, the first clinical equipment of this kind in North America.

A commercial success

Last year, EOS was accredited by both Health Canada and the United States Food and Drug Administration (FDA). EOS III is therefore approved for commercial sale. Through the French company Biospace Med, the technology has since been sold to two Canadian hospitals, Sainte-Justine’s and the Hospital for Sick Children in Toronto, and at least seven hospitals in Europe so far. A first system has just been installed in New Jersey. There is tremendous potential for the use of EOS in orthopedics. It can yield a full head-to-toe 3D skeletal picture from only two simultaneous X-ray images (frontal and profile). Because the patient stands upright during the procedure, the image incorporates the influence of gravity on bone structures. Perhaps most significantly, the patient receives a radiation dose that is 100 to 500 times less than that of a typical scanner.

“In addition to saving images, time and radiation, EOS also costs 50% less than a CT-scan,” says Dr. de Guise, who points out that EOS III does not replace such equipment, but is complementary to it.

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The future looks bright for this France-Quebec technology. Inspired by the benefits to scoliosis patients, researchers have already begun work on extending EOS to imaging upper limbs and skull, as well as detecting bone cancer. The potential applications of EOS are seemingly endless!

The infrastructure for this project was partially funded by the Canada Foundation for Innovation.