The EOS 2D/3D imaging system

The diagnostics advisory committee was informed that the evidence suggests that the EOS system creates images with significant radiation dose reductions compared with other modalities. However, there was uncertainty about the overall impact of that benefit. The external assessment group explored 1 scenario in which cancers were averted at the same time as similar cancers not caused by radiation and 1 scenario in which cancer occurred at the earlier age of 55. The committee understood that cancers induced by radiation may occur even earlier, and averting these would result in increased QALYs. The committee also heard that some rare conditions, such as congenital scoliosis, arising from complex genetic syndromes, might make people more susceptible to radiation damage. The committee identified no other equality issues.

The committee noted that the EOS system may provide throughput improvements because it takes simultaneous images in 2 planes, but no evidence meeting inclusion criteria was available to quantify these improvements.

The committee noted that for the EOS system to be cost effective, benefits relating to the nature of the image need to translate into health benefits for patients. For example, the full-body weight-bearing image generated by the EOS system should provide more accurate information, which might translate into an improved management strategy, and consequently into a health benefit.

On the basis of clinical advice, the committee considered that the EOS system could be an important emerging technology and could offer significant benefits from imaging improvements resulting in better clinical decision-making. The imaging improvements include 3D reconstruction, simultaneous PA and lateral imaging, and whole-body imaging in a single image. Health outcome benefits could result from better decisions about surgery, in particular planning hip and knee replacements, for which knowledge of the position of the pelvis can be important, and possibly managing rare skeletal conditions in children. Other health outcome benefits are possible. No evidence was available for the use of the EOS system for these purposes. Thus, the committee considered further research into these benefits to be necessary and that use of the EOS system in a research setting to develop estimates of these benefits was warranted.

The committee particularly felt there could be specific benefits from the use of the 3D reconstruction from weight-bearing images for both spinal and lower limb conditions. Such reconstructed 3D images are not currently available with existing imaging equipment and are a unique aspect of the EOS system. The committee was unclear about the magnitude of any such benefits, although clinical specialists advised the committee that such benefits may exist. For example, curvature in multiple planes may more accurately predict worsening of scoliosis than the standard approach, which is by measuring the Cobb angle. No data were found to substantiate these benefits.

Based on current evidence, the committee did not consider that the EOS system would be a cost-effective use of NHS resources given the cost of the system and the size of the benefits associated with radiation dose reduction and possible throughput improvements.

As discussed in section 5.7, the EOS system was evaluated primarily for patients with spinal deformities. The committee noted that these are not common enough to allow an EOS system to be fully utilised in most settings. In the committee's view, even adding people with all the conditions included in the scope would not be likely to fully utilise many of the machines that would be needed by the NHS. The EOS system can also be used for other conditions in which conventional radiography would usually be used. The committee considered that all people having imaging with the EOS system might gain from the reduced radiation dose and the system might provide throughput improvements. The committee considered that these benefits were likely to be similar to those in people with spinal conditions (see section 5.6). Considering only these benefits and based on current costs and evidence, it is unlikely that the EOS system would represent a cost-effective use of NHS resources. The EOS system might be found to be cost effective if sufficient benefits arising from the imaging improvements are identified in people with spinal conditions or lower limb problems. These benefits would need to be established by further research.