Imaging in adolescent idiopathic scoliosis: a scoping review of technologies and techniques to reduce radiation exposure and qualitative study of views of health care professionals, patients and carers on imaging

Background: Scoliosis affects up to 5.2% of adolescents between the of age 10 to 18 years. No cause is found in 80% of cases – called adolescent idiopathic scoliosis (AIS). Radiography (X-ray) is the main scoliosis imaging technique. X-ray uses ionising radiation which may harm patients via DNA damage and future generations via hereditary germline mutations. There are other imaging techniques which use no or less radiation, namely slot-scanning technology in EOS systems, and topography. But they are inconsistently available in the National Health Service (NHS). Guidance from the National Institute for Health and Care Excellence (NICE), published in 2011, stated that EOS systems have some benefit in terms of radiation dose reduction and increased patient through-put, but the system was not deemed to be cost-effective. Since 2011, there have been further developments with EOS systems in regards to dose reduction with now a microdose in clinical use. This is not reflected in the NICE guidance. There is no national guidance on topography. In line with the Transforming Imaging Services in England strategy published in 2019, 22 imaging networks have been established in England to improve imaging service delivery. With reconfiguration of imaging services, it is unclear how different AIS imaging technologies are currently used in clinical practice and whether they could be delivered more widely in the NHS. Aim: The aim of this project is to understand the availability of evidence around different AIS imaging techniques, map current AIS imaging service provision and identify areas of improvement in AIS imaging in England. Methods: This project will consist of three work packages. A scoping review to map evidence and identify gaps in research evidence on AIS imaging technologies and techniques that reduce radiation exposure. It will inform plans for future research and/or full systematic review and synthesis of the clinical and cost-effectiveness evidence on AIS imaging. Qualitative interviews to explore views of key stakeholders (patients, carers, health professionals and policymakers) on current AIS imaging service, mode of delivery and information provided to patients and carers. Stakeholders will be invited via the clinical reference group and professional societies and using snowballing techniques to identify any other relevant parties. Patients and carers will be invited via the Scoliosis Support and Research Facebook page. An interdisciplinary stakeholder event where findings of the scoping review and the qualitative work will be presented and discussed to identify areas for improvement in AIS imaging service provision and future research. Timelines: The scoping review and qualitative work will run simultaneously in the first 9 months and stakeholder event in month 10 (overall 12 month study period). Report writing and dissemination is planned for the final 3 months. Anticipated impact and dissemination: In addition to usual academic outputs, the stakeholder event in work package 3 will be a key route to disseminate our findings to AIS imaging/service policymakers. We will share our results with the Scoliosis Support and Research organisation, to relevant health professionals through professional bodies and develop imaging guidance through the Royal College of Radiologists.