Distance from x-ray beam affects magnification of single marker calibration in non-linear fashion

Distance from x-ray beam affects magnification of single marker calibration in non-linear fashion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Distance from x-ray beam affects magnification of single marker calibration in non-linear fashion Chibuzo Akalonu, Spencer Montgomery This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4172935/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Preoperative templating commonly employs the use of a pre-determined size of an external calibration marker used to estimate the size of the final implant. Due to positioning differences of the ball to the X-ray beam, the size of the final implant can be incorrect by several cups sizes. The purpose of this study was to quantify the changes in magnification of a 25mm ECM at several distances between the XR emitter and receiver. Methods We placed 25mm X-ray ball at 100mm distances from the X-ray beam emitter, from 112 to 612mm and measured the size of the external calibration marker on our Picture Archiving and Communication Systems (PACS). Results We found a non-linear size increase as the ECM was placed closer to the X-ray beam with the closest ECM at 612 mm from the plate 5 cup sizes larger than the ECM 112mm from the plate. Conclusion Position of the ECM from the X-ray plate increases the apparent size in a nonlinear fashion as it is moved farther form the x-ray detection plate and closer to the x-ray emitter. Figures Figure 1 Figure 2 INTRODUCTION Preoperative templating in primary total hip arthroplasty is a valuable step that allows for preoperative determination of femoral and acetabular size, positioning of components, neck cut position, offset and leg length 1 . This provides a plan for the surgical team and allows for necessary equipment to be ready when it comes time for surgery 2 , 3 . It also allows the surgeon to prepare for patient related factors that may increase risk of instability and dislocation 4 . Historically, this was completed with acetate templates placed over traditional physical radiographs 5 . With the advent of Picture Archiving and Communication Systems (PACS), digital templating has become more mainstream and is shown to be as accurate as the previous method 1 , 2 , 6 , 7 . Typically, this is achieved with the placement of an external calibration marker (ECM) of a known diameter at the level of the femoral head. A low centered AP pelvis radiograph is then taken. The protocol for this varies depending on the institution – however it is common to place the ECM at the level of the greater trochanter or between the legs at the level of the femoral head. Accuracy of this method can be affected by a multitude of factors such as BMI, inconsistent placement of ECM both in relation to the patient and to the Xray emitter, and the position of the patient 2 , 8 , 9 . In larger patients with fat distribution centered around their hips it may be impossible to place the ECM lateral to the Greater trochanter and still be seen in the image. Additionally, placement between the thighs can be uncomfortable for patients and radiological technologists. Alternatively, Preoperative templating can be completed without the use of an ECM with the use of a set magnification percentage, typically 120%, However, this has proved to be unreliable and often less reliable than using an ECM. 10 It can then be theorized that creating a system that can more accurately predict the size of implants from preoperative radiographs would decrease the amount of inventory present, lead to more predictable surgeries, and possibly better patient outcomes. The purpose of study was to quantify the changes in magnification of a 25mm ECM at several distances between the XR emitter and receiver. METHODS We created a device that would simulate a 25 mm radio-opaque sphere at predetermined points from the XR receiver and emitter. Using PVC pipe, we embedded 6, 25 mm calibrated radio-opaque spheres distanced 100mm from each other. Each ball was oriented 60 degrees from each other allowing us to measure all the markers with a single XR image. We then created a stand with pvc that attached to the spheres (Fig. 1 .). A radiopaque model pelvis was then positioned with the posterior aspect of the pelvis touching the XR monitor in accordance with our institutional protocol. A standard beam to plate distance of 40 inches was used. The space from the Xray plate to the first marker ball was 112 mm. We positioned this in the center of the x-ray beam and obtained our image. Measurements were made utilizing standard calibration of PACS system (Intellispace, Koninklijke Philips N.V. Amsterdam, Netherlands). RESULTS A non-linear increase in size of the marker balls was found in our study (Fig. 2 ). The difference between the ball at 112mm from the Xray plate (25mm) and 212 mm from the plate (28.4) was a little over one cup size. However, the difference between the marker balls at 512 (42.8mm) and 612mm (53.1mm) was over 5 cup sizes. DISCUSSION We found a non-linear increase in templating ball magnification from 25mm to 53.3mm over a span of 112–612 mm from receiver. This highlights the importance of proper x-ray position and, given the challenge posed by some body morphologies, standard magnification of 120% would grossly over or underestimate implant sizes. Additionally, the ECM will also overestimate or underestimate cup sizes if not placed at the exact level of the hip. Ramme et. Al showed a difference of 3.5cm anterior or posterior to the hip joint changed the measured size of the calibration marker by a single cup size 2 . However, they did not explore the entire range of distances and how it contributed to the magnification of the marker ball as many patients eligible for THA have soft tissue envelopes exceeding reliable placement within 3.5 cm. Several other techniques have been developed to attempt to avoid these issues. Three dimensional preoperative templating utilizing computed tomography scans allow for decreased variability in the final size and positioning of the final implant, but at the added cost of increased radiation and healthcare cost 11 – 13 . Other variations of plain film templating have been explored as well. The use of two radiographic calibration markers termed the king mark method, created by the University of Warwick and University Hospitals Coventry and Warwickshire was introduced to circumvent body habitus issues seen in single marker templating. However, it has been shown there is no difference in predicting cup sizes between the single and double marker method 14 . While it is already understood that changes in the position of the templating marker in relation to the hip joint will result in incorrect sizing of final implants. It was interesting to note that the distance from the XR beam affected the size differences in a non-linear fashion. A 100 mm difference at the XR plate only resulted in roughly 1 cup size difference while a marker 100 mm from the hip joint next to the Xray beam could result in a difference of 5 cup sizes. It could be concluded from this study that increasing the distance between the Xray beam and the plate could further reduce the inherent inaccuracy marker ball placement. Declarations Author Contribution All authors contributed to preparing and reviewing the manuscript Funding declaration This research did not receive any funding. References Vigdorchik JM, Sharma AK, Jerabek SA, Mayman DJ, Sculco PK. Templating for Total Hip Arthroplasty in the Modern Age. J. Am. Acad. Orthop. Surg. Publish Ahead of Print, (2020). Ramme AJ, Fisher ND, Egol J, Chang G, Vigdorchik JM. Scaling Marker Position Determines the Accuracy of Digital Templating for Total Hip Arthroplasty. HSS J. 2018;14:55–9. Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg. 2005;13:455–62. Vigdorchik JM, et al. High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty. J Arthroplasty. 2021;36:210–6. Brew CJ, et al. Scaling Digital Radiographs for Templating in Total Hip Arthroplasty Using Conventional Acetate Templates Independent of Calibration Markers. J Arthroplasty. 2012;27:643–7. Holliday M, Steward A. Pre-operative templating for total hip arthroplasty: How does radiographic technique and calibration marker placement affect image magnification? J Med Radiat Sci. 2021;68:228–36. Germain E, et al. Imaging in Hip Arthroplasty Management-Part 1: Templating: Past, Present and Future. J Clin Med. 2022;11:5465. Dammerer D, et al. Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg. 2022;142:2471–80. Sershon RA, Diaz A, Bohl DD, Levine BR. Effect of Body Mass Index on Digital Templating for Total Hip Arthroplasty. J Arthroplasty. 2017;32:1024–6. Thurston D, El-Ashry S, Gella S, Theivendran K. Digital templating in hip hemiarthroplasty: Is it possible to accurately predict femoral head size from magnification alone? J Clin Orthop Trauma. 2022;32:101952. Chen X, et al. Validation of CT -Based Three‐Dimensional Preoperative Planning in Comparison with Acetate Templating for Primary Total Hip Arthroplasty. Orthop Surg. 2022;14:1152–60. Qin J, et al. New technique: practical procedure of robotic arm-assisted (MAKO) total hip arthroplasty. Ann Transl Med. 2018;6:364–364. Jacofsky DJ, Allen M. Robotics in Arthroplasty: A Comprehensive Review. J Arthroplasty. 2016;31:2353–63. Warschawski Y, et al. The accuracy of external calibration markers in digital templating using the double marker and single marker method: a comparative study. Arch Orthop Trauma Surg. 2020;140:1559–65. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4172935","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284765316,"identity":"8d858efd-3e36-4587-86eb-8a1c61d685d5","order_by":0,"name":"Chibuzo Akalonu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACAzB5gEEGSDI+ABI8fMRq4QGSzCAODxspWtgkQGyCWswl0h8++HHGjodfuses8muOnQwbA/PDRzfwaLGckZBs2HMjmUdyzhmz27LbkoEOYzM2zsHnsBsJxyR4PjDzGNzIMbstuY0ZqIWHTRq/lsQ2yT8f6sFaiiW31ROjJZlNmufGYbAWxo/bDhPWYtnzjNlY5sxxHskZacXSjNuO87AxE/CLOXv6w4dvjlXL8Uskb/z4c1u1PT9788PH+LSgAGYeMEmschBg/EGK6lEwCkbBKBgxAABb5kOqN7qseQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Mississippi Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Chibuzo","middleName":"","lastName":"Akalonu","suffix":""},{"id":284765317,"identity":"780c4679-4287-4970-9640-89ca9b2e25e0","order_by":1,"name":"Spencer Montgomery","email":"","orcid":"","institution":"University of Mississippi Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Spencer","middleName":"","lastName":"Montgomery","suffix":""}],"badges":[],"createdAt":"2024-03-27 02:29:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4172935/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4172935/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53878110,"identity":"2736805c-c7e5-43b5-8a6c-829ca7c848df","added_by":"auto","created_at":"2024-04-01 16:58:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":629285,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4172935/v1/0adfa524b884b315506ca202.png"},{"id":53878108,"identity":"acf97048-807c-4ecc-9d13-c3d92b8bbb8b","added_by":"auto","created_at":"2024-04-01 16:58:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4248,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4172935/v1/39ced31bfa5dc0f414aca7b6.png"},{"id":53879826,"identity":"92b8afcc-4440-4bf4-8c39-c0bbec218f8c","added_by":"auto","created_at":"2024-04-01 17:22:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1201693,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4172935/v1/e88865f1-3617-4912-ab97-f75c986fbd5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Distance from x-ray beam affects magnification of single marker calibration in non-linear fashion","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePreoperative templating in primary total hip arthroplasty is a valuable step that allows for preoperative determination of femoral and acetabular size, positioning of components, neck cut position, offset and leg length\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. This provides a plan for the surgical team and allows for necessary equipment to be ready when it comes time for surgery\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. It also allows the surgeon to prepare for patient related factors that may increase risk of instability and dislocation\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Historically, this was completed with acetate templates placed over traditional physical radiographs\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. With the advent of Picture Archiving and Communication Systems (PACS), digital templating has become more mainstream and is shown to be as accurate as the previous method\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Typically, this is achieved with the placement of an external calibration marker (ECM) of a known diameter at the level of the femoral head. A low centered AP pelvis radiograph is then taken. The protocol for this varies depending on the institution \u0026ndash; however it is common to place the ECM at the level of the greater trochanter or between the legs at the level of the femoral head. Accuracy of this method can be affected by a multitude of factors such as BMI, inconsistent placement of ECM both in relation to the patient and to the Xray emitter, and the position of the patient\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn larger patients with fat distribution centered around their hips it may be impossible to place the ECM lateral to the Greater trochanter and still be seen in the image. Additionally, placement between the thighs can be uncomfortable for patients and radiological technologists. Alternatively, Preoperative templating can be completed without the use of an ECM with the use of a set magnification percentage, typically 120%, However, this has proved to be unreliable and often less reliable than using an ECM.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIt can then be theorized that creating a system that can more accurately predict the size of implants from preoperative radiographs would decrease the amount of inventory present, lead to more predictable surgeries, and possibly better patient outcomes. The purpose of study was to quantify the changes in magnification of a 25mm ECM at several distances between the XR emitter and receiver.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe created a device that would simulate a 25 mm radio-opaque sphere at predetermined points from the XR receiver and emitter. Using PVC pipe, we embedded 6, 25 mm calibrated radio-opaque spheres distanced 100mm from each other. Each ball was oriented 60 degrees from each other allowing us to measure all the markers with a single XR image. We then created a stand with pvc that attached to the spheres (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.). A radiopaque model pelvis was then positioned with the posterior aspect of the pelvis touching the XR monitor in accordance with our institutional protocol. A standard beam to plate distance of 40 inches was used. The space from the Xray plate to the first marker ball was 112 mm. We positioned this in the center of the x-ray beam and obtained our image. Measurements were made utilizing standard calibration of PACS system (Intellispace, Koninklijke Philips N.V. Amsterdam, Netherlands).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA non-linear increase in size of the marker balls was found in our study (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The difference between the ball at 112mm from the Xray plate (25mm) and 212 mm from the plate (28.4) was a little over one cup size. However, the difference between the marker balls at 512 (42.8mm) and 612mm (53.1mm) was over 5 cup sizes.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe found a non-linear increase in templating ball magnification from 25mm to 53.3mm over a span of 112\u0026ndash;612 mm from receiver. This highlights the importance of proper x-ray position and, given the challenge posed by some body morphologies, standard magnification of 120% would grossly over or underestimate implant sizes. Additionally, the ECM will also overestimate or underestimate cup sizes if not placed at the exact level of the hip. Ramme et. Al showed a difference of 3.5cm anterior or posterior to the hip joint changed the measured size of the calibration marker by a single cup size\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. However, they did not explore the entire range of distances and how it contributed to the magnification of the marker ball as many patients eligible for THA have soft tissue envelopes exceeding reliable placement within 3.5 cm.\u003c/p\u003e \u003cp\u003eSeveral other techniques have been developed to attempt to avoid these issues.\u003c/p\u003e \u003cp\u003eThree dimensional preoperative templating utilizing computed tomography scans allow for decreased variability in the final size and positioning of the final implant, but at the added cost of increased radiation and healthcare cost\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOther variations of plain film templating have been explored as well. The use of two radiographic calibration markers termed the king mark method, created by the University of Warwick and University Hospitals Coventry and Warwickshire was introduced to circumvent body habitus issues seen in single marker templating. However, it has been shown there is no difference in predicting cup sizes between the single and double marker method\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhile it is already understood that changes in the position of the templating marker in relation to the hip joint will result in incorrect sizing of final implants. It was interesting to note that the distance from the XR beam affected the size differences in a non-linear fashion. A 100 mm difference at the XR plate only resulted in roughly 1 cup size difference while a marker 100 mm from the hip joint next to the Xray beam could result in a difference of 5 cup sizes. It could be concluded from this study that increasing the distance between the Xray beam and the plate could further reduce the inherent inaccuracy marker ball placement.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to preparing and reviewing the manuscript\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVigdorchik JM, Sharma AK, Jerabek SA, Mayman DJ, Sculco PK. Templating for Total Hip Arthroplasty in the Modern Age. \u003cem\u003eJ. Am. Acad. Orthop. Surg.\u003c/em\u003e Publish Ahead of Print, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamme AJ, Fisher ND, Egol J, Chang G, Vigdorchik JM. Scaling Marker Position Determines the Accuracy of Digital Templating for Total Hip Arthroplasty. HSS J. 2018;14:55\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDella Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg. 2005;13:455\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVigdorchik JM, et al. High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty. J Arthroplasty. 2021;36:210\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrew CJ, et al. Scaling Digital Radiographs for Templating in Total Hip Arthroplasty Using Conventional Acetate Templates Independent of Calibration Markers. J Arthroplasty. 2012;27:643\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolliday M, Steward A. Pre-operative templating for total hip arthroplasty: How does radiographic technique and calibration marker placement affect image magnification? J Med Radiat Sci. 2021;68:228\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGermain E, et al. Imaging in Hip Arthroplasty Management-Part 1: Templating: Past, Present and Future. J Clin Med. 2022;11:5465.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDammerer D, et al. Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg. 2022;142:2471\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSershon RA, Diaz A, Bohl DD, Levine BR. Effect of Body Mass Index on Digital Templating for Total Hip Arthroplasty. J Arthroplasty. 2017;32:1024\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThurston D, El-Ashry S, Gella S, Theivendran K. Digital templating in hip hemiarthroplasty: Is it possible to accurately predict femoral head size from magnification alone? J Clin Orthop Trauma. 2022;32:101952.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen X, et al. Validation of CT -Based Three‐Dimensional Preoperative Planning in Comparison with Acetate Templating for Primary Total Hip Arthroplasty. Orthop Surg. 2022;14:1152\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin J, et al. New technique: practical procedure of robotic arm-assisted (MAKO) total hip arthroplasty. Ann Transl Med. 2018;6:364\u0026ndash;364.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacofsky DJ, Allen M. Robotics in Arthroplasty: A Comprehensive Review. J Arthroplasty. 2016;31:2353\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarschawski Y, et al. The accuracy of external calibration markers in digital templating using the double marker and single marker method: a comparative study. Arch Orthop Trauma Surg. 2020;140:1559\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4172935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4172935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePreoperative templating commonly employs the use of a pre-determined size of an external calibration marker used to estimate the size of the final implant. Due to positioning differences of the ball to the X-ray beam, the size of the final implant can be incorrect by several cups sizes. The purpose of this study was to quantify the changes in magnification of a 25mm ECM at several distances between the XR emitter and receiver.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe placed 25mm X-ray ball at 100mm distances from the X-ray beam emitter, from 112 to 612mm and measured the size of the external calibration marker on our Picture Archiving and Communication Systems (PACS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe found a non-linear size increase as the ECM was placed closer to the X-ray beam with the closest ECM at 612 mm from the plate 5 cup sizes larger than the ECM 112mm from the plate.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePosition of the ECM from the X-ray plate increases the apparent size in a nonlinear fashion as it is moved farther form the x-ray detection plate and closer to the x-ray emitter.\u003c/p\u003e","manuscriptTitle":"Distance from x-ray beam affects magnification of single marker calibration in non-linear fashion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 16:58:25","doi":"10.21203/rs.3.rs-4172935/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3848aa8-cd83-4e71-bd40-873b895de2a4","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-01T16:58:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 16:58:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4172935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4172935","identity":"rs-4172935","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}