• Ros Wade, Huiqin Yang, Claire McKenna, Rita Faria, Nigel Gummerson, and Nerys Woolacott.
• Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK. ros.wade@york.ac.uk
• Eur Spine J. 2013 Feb 1;22(2):296-304.

PurposeTo evaluate the available evidence for the clinical effectiveness of the EOS(®) 2D/3D X-ray imaging system for the evaluation and monitoring of scoliosis and other relevant orthopaedic conditions.MethodsA systematic review of studies of EOS(®), compared with standard X-ray film, computed radiography or digital radiography, of patients with orthopaedic conditions was undertaken. Ten electronic databases were searched. The quality of the included studies was assessed and a narrative synthesis undertaken.ResultsThree small, limited quality studies, primarily of children with scoliosis, were identified. No patient health outcomes were reported. Spinal image quality was comparable or better overall with EOS(®). Radiation dose was considerably lower with EOS(®) than X-ray film or computed radiography; the mean entrance surface dose was over five times lower with EOS(®) for the posteroanterior spine radiograph and over six times lower for the lateral spine radiograph.ConclusionsThe available clinical evidence for EOS(®) is limited to establishing its basic technical ability. The technical advancements associated with EOS(®) (the ability to generate a full body scan and to construct a three-dimensional model from synchronously acquired lateral and posteroanterior images) have not been evaluated in terms of their ability to improve patient outcomes. Whilst radiation dose is a concern for orthopaedic patients who require repeated imaging, it is difficult to quantify the reductions in radiation dose seen with EOS(®) in terms of patient health benefits. Clinical studies that investigate the impact of EOS(®) on patient management are required.

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