NICE draft guidance on x-ray imaging system published for consultation

Draft guidance from the new NICE Diagnostics Assessment Programme on a 2D/3D x-ray imaging system is issued today for consultation. The provisional recommendations, the first to be published under the new programme, do not support the routine use of the EOS 2D/3D X-ray imaging system in the NHS. The system is recommended for use in research settings in order to develop evidence about its potentially important clinical benefits.

The EOS Low Dose 2D/3D X-ray imaging system is a novel device that uses low radiation dose imaging to take conventional two dimensional x-ray images as well as 3D reconstructions for some bony body parts. By scanning a line at a time rather than taking the entire image at the same time as per conventional film, computed and digital radiology systems, it allows upright, weight bearing, head-to-toe images to be taken. This capability could help in the management and ongoing monitoring of orthopaedic patients, particularly those with spinal deformities such as scoliosis, or those with leg length discrepancy or alignment problems, by showing the relationship between spine, hip, pelvis and knees to help surgery planning. Imaging systems currently in use cannot image the entire spine or lower limbs in a weight-bearing position without the need for “stitching together” separate images. The EOS system also aims to allow faster patient turnaround.

Professor Adrian Newland, Chair of the independent Diagnostics Advisory Committee, said: "This technology may have a number of potentially significant benefits for patients, and there is evidence to suggest that the system does confer some benefits in terms of reducing radiation dose. Also, simultaneous 2 view imaging may permit improved patient throughput. However, in order for the EOS system to be cost-effective, benefits relating to its use, such as its ability to produce full body upright, weight bearing images in 3D, need to be translated into health benefits for patients. Unfortunately there is no available evidence relating to these benefits. In particular, no data was found that compared the EOS system's diagnostic accuracy to conventional radiological examinations. This, together with the high cost of the system relative to conventional methods of imaging, has led the Committee to provisionally conclude that routine use of the EOS system would not be an effective use of NHS resources.

Professor Newland continued: "One of the functions of NICE's diagnostics guidance is to indicate where we believe that a technology has plausible potential of providing substantial benefits to patients and the NHS, and to suggest what research is required to help address the gaps in the available evidence of these benefits. The Committee is therefore recommending further research on the use of the EOS system to establish whether there are benefits in health outcomes from imaging improvements with the use of this device. In the meantime we look forward to receiving comments on our provisional recommendations from health professionals, industry and patient groups to help inform the development of this guidance."

More information on the diagnostics draft guidance consultation for the EOS Low dose 2D3D X-ray imaging system is available at The consultation closes on 20 June 2011.


Download PDF version

Notes to Editors

About the draft guidance

1. The acquisition cost of the EOS system in the UK is in the region of £400,000, with an annual maintenance cost of £32,000. In addition, X-ray tubes, which need to be replaced every three to five years, cost £25,000.

2. The comparators used in this assessment are computed radiography (CR) and digital radiography (DR). The acquisition cost of CR is approximately £95,000, with an annual maintenance cost of approximately £10,000. CR cassettes require replacement every three to five years at a cost of between £150 and £200. The acquisition cost of DR is between £105,000 and £230,000, with an annual maintenance cost of approximately £18,000. Software upgrades to improve the functionality and performance of DR cost approximately £2,000.

3. The EOS Low Dose 2D/3D X-ray imaging system is manufactured by EOS Imaging.

4. Final guidance on this topic is expected to be published in October 2011.

About the NICE Diagnostics Assessment Programme

5. Further information about the NICE diagnostics assessment programme can be found at:

6. Topics to be considered by the Programme are routed through the related Medical Technologies Assessment Programme. Further information about this can be found at:

About NICE

7. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

8. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

9. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

10. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 27 May 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.