Grivas TB, Soultanis K, Mazioti C, Kechagias V, Akriotis A, Athanasopoulos K, Naskas C, Tagkas D

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1 11 th International Conference on Conservative The double rib contour sign on lateral spinal radiographs: how much the rib index is affected by the distance between the radiation source and the irradiated individual? Grivas TB, Soultanis K, Mazioti C, Kechagias V, Akriotis A, Athanasopoulos K, Naskas C, Tagkas D 1.Traumatology & Orthopaedic Department, "Tzaneio" General Hospital of Piraeus NHS, Tzanni & Afendouli str, 18536, Piraeus, Greece, 2. 1 st Department of Orthopaedics, University of Athens, Atticon University Hospital, Chaidari, Greece 3. Naval Architect & Marine Engineer of National Technical University of Athens, Greece

2 introduction Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

3 11 th International Conference on Conservative All lateral spinal radiographs in idiopathic scoliosis (IS) show a Double Rib Contour Sign (DRCS) of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The rib index (RI) method was extracted from the DRCS to evaluate rib hump deformity in IS patients. The RI was calculated by the ratio of spine distances d1/d2 where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films, while d2 is the distance from the least projection rib contour and the posterior margin of the same vertebra, (Grivas et al 2002). In a symmetric thorax the rib index is 1.

4 11 th International Conference on Conservative Aim This report is the validity study of DRCS, ie how the rib index is affected by the distance between the radiation source and the irradiated child

5 aim Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

6 Method & Material As normal values for the transverse diameter of the ribcage in children aged 6-12 years were used those reported by TB Grivas, PhD thesis Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

7 PhD Thesis "Έρευνα για τα Κάτω Άκρα Παιδιών Πρώτης Σχολικής Ηλικίας" "Survey on the lower limbs of early school age children" /3440?locale=en Degree Grantor: National & Kapodistrian University of Athens Method & Material

8 11 th International Conference on Conservative Methods the American College of Radiology's (2009) guidelines for obtaining radiographs for scoliosis in children recommends that the scoliotic - films distance to be 1,80 meters.

9 11 th International Conference on Conservative Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

10 11 th International Conference on Conservative Euclidean geometry Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

11 Results Using the Euclidean geometry it is shown that in a normal child 12 years of age, provided that the distance Z 12cm (11,84) & EA = 180cm, with transverse ribcage diameter of the child 22 cm, then d1/d2 = In child 12 years of age, provided that: Ζ 12cm & EA = 180cm & the thoracic transverse diameter = 22cm then: d 1 /d 2 = This validity study demonstrates that the DRCS is substantially true & practically the RI is not affected by the distance between the radiation source & the irradiated child

12 11 th International Conference on Conservative Conclusions The RI is valid & may be used to evaluate the effect of surgical or conservative treatment on the rib cage deformity (hump) in children w/ IS It is noted that IR is a simple method & a safe reproducible way to assess the rib hump deformity based on lateral radiographs, w/out the need for any other special radiographs & exposure to additional radiation

13 References Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Grivas TB, Daggas S, Polyzois BD, Samelis P (2000). The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis. Oral Presentation: 2000 Meeting of the International Research Society of Spinal Deformities. Clermont, France, May Proceedings of the meeting page 9 Grivas TB, Dangas S, Polyzois BD, Samelis P: The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis. Stud Health Technol Inform. 2002; 88: Grivas TB, Vasiliadis E, Dangas S (2005): The importance of double rib contour sign in the aetiology of idiopathic scoliosis. Podium (Oral) Presentation: Annual Meeting of Spinal Experts Group. Hyatt Regency Hotel, Thessaloniki Greece, December Abstract Publication: in proceedings of the meeting, p.42. American College of Radiology (ACR) SPR practice guideline for the performance of radiography for scoliosis in children. Revised 2009, Γρίβας ΘΒ (1988): Έρευνα για τα Κάτω Άκρα Παιδιών Πρώτης Σχολικής Ηλικίας. Survey on the lower limbs of early school age children. ιδακτορική ιατριβή, Εθνικό Καποδιστριακό Πανεπιστήμιο Αθηνών. Lykissas MG, Sharma V, Crawford AH. Assessment of Rib Hump Deformity Correction in Adolescent Idiopathic Scoliosis With or Without Costoplasty Using the Double Rib Contour Sign. J Spinal Disord Tech Sep 28. [Epub ahead of print]. Grivas TΒ, Triantafyllopoulos G, Mazioti C (2013): Assessment of early rib hump deformity correction in adolescent idiopathic scoliosis treated with a dynamic derotation brace using the double rib contour sign. 10th International Conference on Conservative Management of Spinal Deformities, 8th SOSORT Annual Meeting, Proceedings Book of the Meeting, page 37, Chicago, Illinois, USA Wednesday, May 8 through Saturday, May 11, Grivas TΒ, Triantafyllopoulos G, Mazioti C: Assessment of early rib hump deformity correction in adolescent idiopathic scoliosis treated with a dynamic derotation brace using the double rib contour sign. Scoliosis 2013, 8(Suppl 2):O54. Σταυρόπουλος ΝΑ, Σουλτάνης ΚΧ, Γρίβας ΘΒ Σταρατζής Κ, Τσιάβος Κ, Σαρλικιώης ΤΑ, Μιμίδης Γ, Παπαγγελόπουλος ΠΓ (2013): Αξιολόγηση της διόρθωσης της ασυμμετρίας των πλευρών στη χειρουργική αντιμετώπιση της ιδιόπαθους εφηβικής σκολίωσης σε δυο τύπους σπονδυλολυσίας. Stavropoulos NΑ, Soultanis KC, Grivas TΒ, Starantzis KA, Tsiavos K, Sarlikiotis T, Mimidis G, Papagelopoulos PJ. Measurement of rib hump deformity correction in adolescent idiopathic scoliosis treated with full screw or hybrid constructs using the double rib contour sign. Προφορική - Ελεύθερη Ανακοίνωση, 7ο Πανελλήνιο Συνέδριο Σπονδυλικής Στήλης, , Makedonia Palace, Θεσσαλονίκη. Σταυρόπουλος ΝΑ, Σουλτάνης ΚΧ, Γρίβας ΘΒ Σταρατζής Κ, Σαρλικιώης ΤΑ, Τσιάβος Κ, Παπαγγελόπουλος ΠΓ (2013): Αξιολόγηση της διόρθωσης της ασυμμετρίας της σπονδυλικής στήλης και του θωρακικού κλωβού σε ασθενείς με Ιδιόπαθη Εφηβική Σκολίωση μετά από οπίσθια σπονδυλολυσία με διαυχενικούς κοχλίες. Stavropoulos NΑ, Soultanis KC, Grivas TB, Starantzis KA, Sarlikiotis T,Tsiavos K, Papagelopoulos PJ. Assessment of spinal and thoracic deformity correction in adolescent idiopathic scoliosis using powerful full screw constructs. Προφορική- Ελεύθερη Ανακοίνωση, 7ο Πανελλήνιο Συνέδριο Σπονδυλικής Στήλης, , Makedonia Palace, Θεσσαλονίκη. Stavropoulos NA, Soultanis KC, Grivas TB, Tsiavos K, Starantzis K, Sarlikiotis T, Karamanis E, Papagelopoulos PJ (2014): Measurement of rib hump deformity correction in adolescent idiopathic scoliosis treated with full screw or hybrid constructs using the double rib contour sign. 15th EFORT Congress, London, United Kingdom, 4-6 June Grivas TB, Soultanis K, Mazioti C, Kechagias V, Akriotis A, Athanasopoulos K, Naskas C, Tagkas D (2014): The double rib contour sign on lateral spinal radiographs: how much the rib index is affected by the distance between the radiation source and the irradiated individual? 11 th International Conference on Conservative, 9th SOSORT Annual Meeting, 8-10 May 2014, Wiesbaden, Germany. Soultanis K, Tsiavos K, Grivas TB, Stauropoulos N, Maurogenis A, Papaggelopoulos PJ (2014): Reliability study for the rib index in chest radiographs of a control group. 11th International Conference on Conservative, 9th SOSORT Annual Meeting, 8-10 May 2014, Wiesbaden, Germany. Andrea Lebel Rib index, an objective measure to document changes of the rib hump deformity in a risser 4 progressive AIS patient treated with the Schroth method. 11th International Conference on Conservative, 9th SOSORT Annual Meeting, 8-10 May 2014, Wiesbaden, Germany

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