EOS – A new frontier in spine imaging

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 3-8 | Bhavuk Garg, Pulak Vatsya

DOI: 10.13107/jcorth.2022.v07i01.457

Author: Bhavuk Garg [1], Pulak Vatsya [1]

[1] Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India


Address of Correspondence
Dr. Bhavuk Garg,
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.


EOS is a new tool in the armamemtarium of orthopedicians. Its ability to give a standing 3 dimesnionla image of the spine, has made it an indespenisble tool, specially for spine surgeons. Scoliosis is a 3 dimesnional deformity with multiple compensatory mechanisms being applied at the level of the pelvis and lower limbs as well as in spine. Operating on such patients needs thorough understanding of the 3D anatomy. EOS, provides this along with its low radiation dose, quick scan time and ability to repeat test multiple times if needed. The uses of this modality is on the rise, and as awareness and accessibility to EOS increases, so will the diversity of uses of this tool. Spine surgeons need to understand and use EOS for planning of their surgeries more compared to orther specializations of orthopaedics. EOS is truly a game-changer for spine imaging.

Keywords: EOS, 3dimesnional scans, scoliosis surgery, spine radiographs, novel methods


  1. Dubousset J, Charpak G, Dorion I, Skalli W, Lavaste F, Deguise J, et al. Anew 2D and 3D imaging approach to musculo-skeletal physiology and pathology with low-dose radiation and the standing position: The EOS system. Bull Acad Natl Med 2005;189:287-300.
  2. Wybier M, Bossard P. Musculoskeletal imaging in progress: The EOS imaging system. J Bone Spine 2013;80:238-43.
  3. Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS (®) biplanar X-ray imaging: Concept, developments, benefits, and limitations. J Child Orthop 2016;10:1-14.
  4. Garg B, Mehta N, Bansal T, Malhotra R. EOS® imaging: Concept and current applications in spinal disorders. J Clin Orthop Trauma 2020;11:786-93.
  5. Al-Aubaidi Z, Lebel D, Oudjhane K, Zeller R. Three-dimensional imaging of the spine using the EOS system: Is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B 2013;22:409-12.
  6. Delin C, Silvera S, Bassinet C, Thelen P, Rehel JL, Legmann P, et al. Ionizing radiation doses during lower limb torsion and anteversion measurements by EOS stereoradiography and computed tomography. Eur J Radiol 2014;83:371-7.
  7. Luo TD, Stans AA, Schueler BA, Larson AN. Cumulative radiation exposure with EOS imaging compared with standard spine radiographs. Spine Deform 2015;3:144-50.
  8. Vidal C, Ilharreborde B, Azoulay R, Sebag G, Mazda K. Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J 2013;22:1362.
  9. Newton PO, Fujimori T, Doan J, Reighard FG, Bastrom TP, Misaghi A. Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 2015;97:1694-701.
  10.  Parvaresh KC, Osborn EJ, Reighard FG, Doan J, Bastrom TP, Newton PO. Predicting 3D thoracic kyphosis using traditional 2D radiographic measurements in adolescent idiopathic scoliosis. Spine Deform 2017;5:159-65.
  11. Hayashi K, Upasani VV, Pawelek JB, Aubin CÉ, Labelle H, Lenke LG, et al. Three-dimensional analysis of thoracic apical sagittal alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009;34:792-7.
  12. Ferrero E, Mazda K, Simon AL, Ilharreborde B. Preliminary experience with SpineEOS, a new software for 3D planning in AIS surgery. Eur Spine J 2018;27:2165-74.
  13.  Lau LC, Hung AL, Chau WW, Hu Z, Kumar A, Lam TP, et al. Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: A feasibility and validity study. J Child Orthop 2019;13:385-92.
  14. Somoskeöy S, Tunyogi-Csapó M, Bogyó C, Illés T. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 2012;12:1052-9.
  15.  Ilharreborde B, Ferrero E, Alison M, Mazda K. EOS microdose protocol for the radiological follow-up of adolescent idiopathic scoliosis. Eur Spine J 2016;25:526-31.
  16. Ilharreborde B, Dubousset J, Skalli W, Mazda K. Spinal penetration index assessment in adolescent idiopathic scoliosis using EOS low-dose biplanar stereoradiography. Eur Spine J 2013;22:2438-44.
  17. Wade R, Yang H, Mckenna C, Faria R, Gummerson N, Woolacott N. Asystematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 2013;22:296-304.
  18. Hirsch C, Ilharreborde B, Mazda K. EOS suspension test for the assessment of spinal flexibility in adolescent idiopathic scoliosis. Eur Spine J 2015;24:1408-14.
  19. Labelle H, Aubin CE, Jackson R, Lenke L, Newton P, Parent S. Seeing the spine in 3D: How will it change what we do? J Pediatr Orthop 2011;31 Suppl 1:S37-45.
  20. Le Huec JC, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: Normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J 2015;24:63-71.
  21. Haidekker MA, Andresen R, Werner HJ. Relationship between structural parameters, bone mineral density and fracture load in lumbar vertebrae, based on high-resolution computed tomography, quantitative computed tomography and compression tests. Osteoporos Int 1999;9:433-40.
  22. Sapin-De Brosses E, Jolivet E, Travert C, Mitton D, Skalli W. Prediction of the vertebral strength using a finite element model
    derived from low-dose biplanar imaging: Benefits of subject-specific material properties. Spine (Phila Pa 1976)
  23.  Sapin E, Briot K, Kolta S, Gravel P, Skalli W, Roux C, et al. Bone mineral density assessment using the EOS low-dose X-ray device: A feasibility study. Proc Inst Mech Eng H 2008;222:1263-71.
  24. Moltó A, Freire V, Feydy A, Paternotte S, Maksymowych WP, Benhamou M, et al. Assessing structural changes in axial spondyloarthritis using a low-dose biplanar imaging system. Rheumatology 2014;53:1669-75.
  25.  Illés T, Tunyogi-Csapó M, Somoskeöy S. Breakthrough in three-dimensional scoliosis diagnosis: Significance of horizontal plane view and vertebra vectors. Eur Spine J 2011;20:135-43.
  26. McKenna C, Wade R, Faria R, Yang H, Stirk L, Gummerson N, et al. EOS 2D/3D X-ray imaging system: A systematic review and economic evaluation. Health Technol Assess 2012;16:1-188.
  27. Bouloussa H, Dubory A, Seiler C, Morel B, Bachy M, Vialle R. A radiolucent chair for sitting-posture radiographs in  non-ambulatory children: Use in biplanar digital slot-scanning. Pediatr Radiol 2015;45:1864-9.
  28.  Faria R, McKenna C, Wade R, Yang H, Woolacott N, Sculpher M. The EOS 2D/3D X-ray imaging system: Acost-effectiveness analysis quantifying the health benefits from reduced radiation exposure. Eur J Radiol 2013;82:e342-9.

How to Cite this article: Garg B, Vatsya P. EOS – A New Frontier in Spine Imaging. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):3-8.

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