Courtney Collen (Host): Hi there. Welcome to our medical series Called to Care by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. Called to Care brings forward medical experts who can give fellow clinicians some advice and guidance that they can use in their primary care practice and more information about when it’s time to refer patients and families to more specialized care. Joining me for these conversations is Joseph Segeleon, MD, who is vice president and medical officer for Sanford Children’s Hospital and a leader in pediatric critical care. He’s here to help us dive even deeper into these topics to provide the best insight and care for our patients and communities.
Welcome, Dr. Segeleon, good to see you.
Dr. Joseph Segeleon: Courtney. It’s really nice to be here. Good to see you again.
Courtney Collen (Host): I’m looking forward to this conversation. And we’re talking today about EOS technology, which is a full body imaging scan that uses far less radiation than a traditional scan and Sanford Health in Sioux falls is the only facility right now that offers this type of imaging. So to help us dive a little deeper into this topic is Dr. Jeff Haft, an orthopedic surgeon who specializes in spine disorders and pediatric orthopedics. Welcome Dr. Haft.
Dr. Geoffrey Haft: Thank you. Thanks for the opportunity to talk about EOS today. I’m excited to have the conversation. Thanks, Joe.
Dr. Joseph Segeleon: It’s great to see a Dr. Haft and wonderful to be talking about this. This is something I admit that I know nothing about, which is which is great to be able to learn. And it’s also exciting to be able to learn more of this from someone that I’ve had the privilege of working beside as a clinician and we are so thankful that he is in our community and I’ve really enjoyed our working relationship.
Why don’t we start off for our listeners with what is exactly a pediatric orthopedist? Maybe tell us a little bit about your training.
Dr. Geoffrey Haft: Sure. So I all pediatric orthopedist complete a orthopedic surgery residency, which is five years. And then people do additional training in pediatric orthopedics, which can be one to two years, depending on which, which course of study people pursue. I spent a year after residency doing a fellowship that focused a lot on pediatric spine deformity, which people think of as scoliosis. And we also in pediatric orthopedics take care of a slew of other conditions that are, are conditions that none of my adult partners ever want to see or take care of. These things include hip dysplasia club feet cerebral palsy, spinal bifida a number of syndromic disorders, skeletal dysplasias, pediatric trauma. So it’s, it’s a, it’s a lot of different conditions, many of which are somewhat rare and many all of which are pretty specialized and require a person with additional training to manage them properly.
Dr. Joseph Segeleon: Great. Thank you. That helps. And I appreciate the expertise that you bring to the care of those children that have a number of those illnesses and chronic conditions that you mentioned. Well, we’ll go ahead and get to the topic at hand. What is EOS?
Dr. Geoffrey Haft: So EOS – it’s E O S – is the proprietary name for the technology and device. That is a specialized x-ray system. So in simple terms, EOS is a fancy x-ray system.
Dr. Joseph Segeleon: I know that you are a strong advocate to bring EOS technology to the Sanford Children’s Hospital. What are the advantages of this?
Dr. Geoffrey Haft: The disadvantage of EOS is that it’s expensive. So it took a pretty big effort to get the capital and dollars to bring it here. The rationale for doing it though was twofold. First, and most importantly, it’s dramatically less radiation for all patients and in particular, our pediatric patients. So the standard EOS x-ray has one-ninth, the radiation of a standard x-ray, and there’s also something called. We have a called a micro dose protocol, where, where you can use even less radiation, which is one 43rd, the standard dose of radiation. So you can get 43 x-rays for the price of one from a radiation standpoint. So the radiation reduction is, I would say, the number one reason we like it. The number two reason, and this is even more surprising when you start using it, is the image quality is much better than traditional x-ray. So, the crispness of the anatomy is incredible when you put it side by side with a comparable x-ray using standard x-ray technology or radiology.
Dr. Joseph Segeleon: And from the type of patients you take care of – and from the research that I did – this reduced radiation is particularly important for children who are getting multiple x-rays throughout their life?
Dr. Geoffrey Haft: Sure. We have children with what we call early onset scoliosis, who may be three or four years old, and they get multiple x-rays a year, year after year after year. And the radiation exposure is not insignificant. And this allows us to reduce their radiation dose by anywhere from 10 to 40 times over the course of their childhood. It’s fantastic. One of the things that drove this acquisition frankly, is that parents are very well-educated now. And I hardly had a day that went by where someone didn’t come in and poke me in the chest and say, why don’t you guys have this imaging technology here in our region? And we do, we’ve had it now since April. So it’s been wonderful.
Dr. Joseph Segeleon: Well, I applaud you for your efforts and for those parents speaking out for their children. Now, is it specifically just for children or can it be used for adults as well?
Dr. Geoffrey Haft: It can be used for adults as well, and it’s not just used for spine imaging. It’s used for any imaging. You can get with a patient standing up so we can take x-rays of the pelvis. We take full body imaging from the head all the way to the toes, which you’d wonder why a person needs that, but there are a lot of spine deformity applications where we like to see, what we call global body balance, where you can see from the position of the skull relative to the ankles. And a lot of our joint replacement specialists prefer these images for preoperative planning and post-operative assessment as well. The imaging has been so popular, they’ve had to already build out an additional weighting and changing room down there because it’s used all day, every day.
Dr. Joseph Segeleon: Thanks. That’s very helpful. I had not realized that the folks that do joint replacements also use it and you of course use it for your patients as well. Now, is it always standing or does, can the person, if they’re not able to stand, is it sitting as well?
Dr. Geoffrey Haft: So we have the latest generation of the EOS imaging it’s called EOS edge. We’re one of two sites in the U.S. to have the latest imaging… that I think the other one is Cleveland Clinic, or somewhere in Ohio, the original EOS system allowed for seated x-rays or seated scoliosis images, the new device where the patient’s actually up on a platform does not have an approved chair yet for seated imaging that is coming. So we, you know, we have a number of patients who are non-ambulatory and right now our system cannot accommodate them, but we’re working on it.
Dr. Joseph Segeleon: Okay. Perfect. Thank you. How long does the scan take?
Dr. Geoffrey Haft: It takes a second? It’s immediate. The other beautiful part about it, well there’s several things … first is, the images are not stitched together electronically. It’s all one image. So you don’t have any distortion around the edges of the image. It’s also calibrated. So you can measure lengths on the image that are accurate without any additional calibration or without a ruler on the image. So for instance, if you want it to measure the, the width of a bone or, or the length of a femur for a limb length inequality, you can just measure directly from our PAC system. And it’s accurate.
Dr. Joseph Segeleon: I realized that you interpret most of your x-rays, but is there any special training that our radiologists or an orthopedist would require so that they could read the images from EOS?
Dr. Geoffrey Haft: There’s not. There are some sophisticated measurements we do related to spine deformity that are automated with the new system. So there’s, there’s things I used to do that took me half an hour to measure. And now it automatically measures these things and gives you a printout of all these different parameters. So it’s just like all newer technology. It automates many processes that we previously did by hand and saves us a lot of time.
Dr. Joseph Segeleon: Okay. So it sounds like it easy to do it doesn’t take a lot of time. You have significantly reduced radiation and the usages can be for children, as well as adults. Are there any downsides to the technology, since you’ve had it since April, that you’ve found?
Dr. Geoffrey Haft: Not really. One downside is it requires its own room and space and waiting rooms. So we had to, in addition to the cost of the, of the technology itself, we had to invest temp in a little additional space. Otherwise I don’t see any major downsides. I think the biggest problem that we’re going to have long-term is we’re going to need more than one of them because it’s so popular.
Dr. Joseph Segeleon: I think a lot of the providers out there, this EOS technology and the machine first off, probably a lot of the providers like myself, have never really seen the machine. And then they’re just learning about this technology. Who can order images using this technology?
Dr. Geoffrey Haft: Anyone can order it. Any doctor in the community and the state can order it and use it, just like if you’re ordering an MRI scan. So we’ve tried to let our primary care doctors and pediatricians know about it. And there are a lot of people who have already begun ordering images on their patients and rather than doing them in their office, sending them over, understanding the radiation differences.
Dr. Joseph Segeleon: I did not know that. That’s interesting. Let me ask you a question, just to clarify. So a child comes into the ER, they broke their arm… Is there an indication for it there?
Dr. Geoffrey Haft: Probably not for an extremity isolated injury where patients going to be shielded from radiation anyway. Not, not really a good application there.
Dr. Joseph Segeleon: Okay. So for our primary care providers out there, who may or may be interested in ordering this, what kind of reasons would they have for specifically ordering the EOS technology?
Dr. Geoffrey Haft: The three most common reasons would be number one, spine deformity, which would be scoliosis or abnormal kyphosis. The second reason would be concerns about limb length, inequality, get a standing images that can show you whether the bones are truly different in length or not. And the third reason would be concerns about limb alignment, such as knock knees or genu valgum. Those would be the most common reasons that a primary care doctor would want to order an EOS image.
Dr. Joseph Segeleon: Thank you. That that’s very useful information. Thank you. And I’m sure our primary care providers that are listening will not only appreciate this resource, but also appreciate the access to this resource. That being one of two sites in the United States. Fantastic.
Is there anything else specifically about the EOS that we should discuss today?
Dr. Geoffrey Haft: The only thing I would add is I think I’m appreciative of the efforts of people who have fundraised around a Children’s Miracle Network and, and the effort that a Sanford administration made to get the capital together to acquire the technology. I think it was a collaborative effort and I think that our foundation was involved as well. So I think this is an important example of what happens to these dollars, you know, where they get invested. I think this is a good investment, not just in our health system, but the whole region, the closest EOS system outside of Sioux Falls would be in Rochester, Minnesota, or Omaha, Nebraska.
Courtney Collen (Host): What does it mean for you as a physician to have this technology here at Sanford in Sioux Falls?
Dr. Geoffrey Haft: Well, it means a lot to me, it gives me confidence that we’re, we’re giving our patients the safest care we can give them.
Dr. Joseph Segeleon: Well, thanks. I appreciate those words and really appreciate your leadership in bringing this technology to us. I know we have two pediatric orthopedists at Sanford Children’s. And as I said, in the beginning of the show, I I’ve had the privilege of working alongside you as a clinician. What are some of the other accommodations that we make for children that you may see either as an outpatient or an inpatient? What do we do just for kids?
Dr. Geoffrey Haft: Okay. Well, one thing we do is try to have a multi-specialty clinics for some of our special needs groups of children. And examples of this would be spasticity clinics, spinal bifida clinics, skeletal dysplasia clinics … The idea behind this, as many of these special needs, children have to see subspecialists in various specialties multiple times a year, and it ends up being a huge ordeal for the families to come in for separate appointments, to see sub-specialists, these multi-specialty clinics allow patients to come in one morning or one afternoon and see three or four or five sub-specialists all at once. It makes it a lot easier on families that are already, probably at their wit’s end, traveling back and forth from three hours away to see people in multiple subspecialty areas. So that’s one of the accommodations we make.
I think the other accommodation that Sanford specifically makes is having a standalone children’s hospital full of sub-specialists who can take care of complex problems. Dr. Segeleon recognizes this, but we have invested for two decades in developing a team of specialists who can take care of just about any problem that exists in our pediatric world. And that’s probably the biggest accommodation we make regionally. There is no other regional hospital that does what we do. None.
Dr. Joseph Segeleon: Yeah. And I appreciate that. And I know my observation would be you know, we have pediatric physical therapy, we have OT, child life, pediatric nurses specifically trained pediatric pharmacists, pediatric hospitalists. So it really does take a team to take care of these children and appreciate what we have developed here and all the resources that we have that we can take care of these children. And EOS is just one of those that really makes us stand out and allows us to, to take care of those children with the resources that is the safest for them. Finally. If a provider out there has a once pediatric orthopedic advice has patients they want to refer to you, how would they go about doing that?
Dr. Geoffrey Haft: So that’s, that’s another great question. As you know, I’ve got a partner Dr. Jared Daniel, who came here a couple of years ago from Des Moines. He’s been practicing peds now for five or six years, and he arrived here and he’s took him about one year and he’s as busy as I am. So there’s, there’s a tremendous amount of pediatric orthopedic conditions out there. What we have done is every single day, Monday through Friday, one of us is in clinic all day, and we have a we have a system in place where by any provider who wants either to refer someone or immediate advice on a pediatric condition, it’s usually trauma or infection can reach us. They can either call the clinic, or there’s a through the one call system we’re on the call schedule every day. And the pager goes directly to us. So we’re answering pages when we’re in clinic for all types of problems, as an example of this. And I just want to share this example, because the other question you just asked, I got called today 2:00 PM about a child who I, I believe ultimately is going to have a malignant tumor. We’re able to get the patient in today from somewhere else in the region. Now that patient’s been admitted by our pediatric hospitalist team will be seen by our pediatric oncologists. We do have a new partner here at Sanford, Josh Johnson, who’s a musculoskeletal oncology expert and did just completed a tumor fellowship in orthopedics. So this just speaks to the type of team that has been put together here over the course of mine and your careers. I mean, you and I, as you mentioned, we’ve been here a long time. And what we have today is, is a result of the efforts of hundreds and hundreds of people over two decades. So it’s a wonderful thing to see.
Dr. Joseph Segeleon: Well, thanks. I appreciate your comments and, and really marvel at the ease at which people can get in contact with you. And hopefully if there’s someone listening and they were unaware of the, the ease of which you can get ahold of Dr. Haft, his partner and tap into this expertise this helps inform. Courtney, I will throw it back to you.
Courtney Collen (Host): Dr. Segeleon, thank you, Dr. Haft. Thank you so much for your insight and expertise on EOS technology and all that you do to provide care to patients here at Sanford. Thanks again.
Dr. Geoffrey Haft: Of course. My pleasure. Thanks for having me. Thank you.
Courtney Collen (Host): Our Called to Care podcast series by providers, for providers continues right here with our Sanford Health experts. I’m Courtney Collen. Thank you so much for being here. We’ll see you soon.
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