The potential benefits of a promising new imaging system to be explored further in new research

In final guidance on the EOS 2D/3D imaging system (EOS Imaging) published today (26 October) as part of its diagnostics guidance programme, NICE has called for the clinical benefits of the potentially important new X-ray technology to be explored by encouraging the use of the technology in research settings.

The EOS Low Dose 2D/3D imaging system is a novel device that uses low dose radiation imaging to produce conventional two dimensional x-ray images as well as 3D reconstructions for some bony body parts. Slot-scan technology allows it to scan a line at a time rather than taking the entire image at the same time as per conventional film, computed and digital radiology systems. This enables upright, weight bearing, head-to-toe images to be produced. Although the EOS 2D/3D imaging system can be used for many types of radiological examinations, by showing the relationship between spine, hip, pelvis and knees it could offer particular benefits in the management, including surgery planning, and ongoing monitoring of patients with spinal deformities such as scoliosis, or those with leg length discrepancy or alignment problems,. 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.

Also, because the EOS system uses a lower radiation dose than conventional radiography, it has potential advantages for use in patients with spinal deformities who often require repeated imaging, often from a very young age.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “There is evidence showing comparable or better images and radiation dose reduction associated with using the EOS system to image patients with spinal deformities. However, there is currently no available evidence that specifically compares the diagnostic accuracy of the EOS system, and subsequent health benefits for patients, with that of conventional radiological examinations for the wider orthopaedic patient population. An important feature of the NICE Diagnostics Assessment programme is expertise and capacity for facilitation of the development of further evidence. Where the relevant NICE advisory committee identifies that a technology has considerable potential but insufficient evidence to support widespread adoption across the NHS, it may make recommendations for further research. The EOS 2D/3D imaging system was identified by the Diagnostics Advisory Committee as an important emerging technology. NICE will follow up the Diagnostics Advisory Committee's research recommendations on the EOS 2D/3D system and will assess the feasibility of this research with a view to facilitating the development of further relevant evidence.”


Notes to Editors

About the guidance

1. The guidance on the EOS imaging system is available on the NICE website at

2. 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.

3. 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.

4. The EOS Low Dose 2D/3D imaging system is manufactured by EOS Imaging.

5. NICE recently announced the appointment of new external assessment centres to support its guidance production and associated processes. These will provide independent assessment of the evidence for medical technologies and related economic analysis. They will also have a central role in developing and facilitating independent research products to assist manufacturers when NICE medical technology or diagnostics guidance recommends that further research should be carried out.

About the NICE Diagnostics Assessment Programme

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

7. 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

8. 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.

9. 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.

10. 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

11. 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: 26 October 2011

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