The newly named Penny Doerge Adaptive Academy (PDAA) honors the memory of HSS patient Penny Doerge and will continue to offer trips and recreational and creative activities such as rock climbing, surfing, skiing, dancing and other exciting adventures to pediatric patients at no cost, as it has for the past decade. The activities aim to build self-confidence, encourage independence, reinforce therapy goals and increase physical activity, creativity and mobility. Penny, a longtime patient of Roger Widmann, MD, chief of Pediatric Orthopedics at HSS, embodied the spirit of the program for kids and teens with a range of disabilities.

“Penny was an independent spirit who had a force of personality and a drive to do everything that her peers and her brothers would and could do,” Dr. Widmann said. “She also had an incredible artistic sense and style that defined her from early on. We miss her very much.”

The Penny Doerge Adaptive Academy focuses on three themes that are central to how Penny lived her life: motion, expression and inclusion, explained Kate Doerge, Penny’s mother and member of the HSS Board of Trustees, Pediatric Council, and Co-Chair of the HSS Board of Advisors. “Her resiliency, positivity and courageousness are all qualities that the Academy works to promote in its participants,” she said.

Penny was diagnosed with neurofibromatosis as an infant but never let her diagnosis hold her back. She lived a life full of purpose, passion and joy, according to HSS staff who knew her.

The renaming of the Academy will be celebrated at the 2023 Hospital for Special Surgery Benefit for Pediatrics on November 8. The event, which will take place at The Lighthouse at Chelsea Piers, raises funds for the Lerner Children’s Pavilion at HSS, which offers the Academy’s programs. Additional support will enable the Academy to expand its offerings to all HSS patients ranging in age from 3 to 22.  

The Academy organizes trips and recreational experiences to enable young patients with cerebral palsy or another physical condition affecting movement, muscle control or balance to participate in athletic or recreational activities they may have never dreamed possible. Many of the participants have had surgery at HSS. Adaptive activities are geared toward people with differing abilities. Sometimes rules and equipment are modified to meet the needs of participants.

“Patients who participate in the Academy gain greater confidence in their physical capabilities, and they carry that with them to school and beyond,” said Lisa Ipp, MD, chief of Pediatric Medicine at HSS and co-executive director of the Academy. “It has become a very special part of HSS, bringing comfort, excitement and joy to our youngest patients.”  

Dr. Mayman will succeed Mathias P. Bostrom, MD, who, along with sports medicine surgeon Answorth A. Allen, MD, was recently appointed Associate Surgeon-in-Chief at HSS after serving as ARJR chief for the past four years. Dr. Green will succeed Roger F. Widmann, MD, who has led the Pediatric Surgical Service since 2004. Dr. Widmann will continue to care for pediatric patients with spine and limb deformities and will lead a new center of excellence dedicated to robotic-assisted surgery at HSS. Both appointments will go into effect September 5.

“We are grateful to Drs. Bostrom and Widmann for their steadfast leadership over the years,” said Bryan T. Kelly, MD, MBA, president, surgeon-in-chief and medical director of HSS. “Drs. Mayman and Green are not only talented surgeons, they are collaborative leaders who bring a wealth of expertise and experience to their new roles. These appointments will allow us to continue to advance excellence for our joint replacement and pediatric surgical patients.”

In their new roles, Drs. Mayman and Green will each lead highly integrated multidisciplinary teams. The ARJR service is comprised of programs focused on hip and knee osteoarthritis and other problems requiring joint replacement in adults, while Pediatrics covers the spectrum of conditions requiring orthopedic surgery in children, ranging from sports medicine injuries and trauma to congenital issues of the spine and hip.

David Mayman

David J. Mayman, MD, is an orthopedic surgeon specializing in hip and knee replacements. A member of the Hip and Knee Societies, Dr. Mayman is a leader in the field of robotic and navigated joint replacement surgery. His primary research interest lies in incorporating new technologies into arthroplasty, with the goal of achieving more favorable outcomes for patients.

“I’m honored to take on this new role, leading and collaborating with a deeply talented team of surgeons in order to deliver scientific breakthroughs and address joint pain challenges,” said Dr. Mayman. “HSS is recognized as the leader in joint replacement, and by harnessing the power of our musculoskeletal expertise, we will advance the overall health and wellness of generations to come.” 

Daniel Green

Daniel W. Green, MD, MS, is a pediatric orthopedic surgeon specializing in knee surgery.

A holder of the Mary Kathryn and Alexander Navab Chair for Pediatric Orthopedic Research at HSS, Dr. Green’s clinical research has focused on surgical outcomes and techniques used to treat patella dislocation, osteochondritis dissecans, discoid meniscus and pediatric ACL tears.

“I am honored to be asked to represent such a talented group of pediatric orthopedic surgeon leaders dedicated to taking care of children at the hospital ranked no. 1 in the world for orthopedics,” said Dr. Green. “We are positioned to maintain our leadership position as national and international thought leaders and dedicated to increasing access to our care.”

“HSS is home to an unparalleled number of talented and knowledgeable experts who specialize in caring for patients with various conditions throughout the lifespan,” said Louis A. Shapiro, CEO of HSS. “These appointments highlight the depth of leadership and experience across each area of the organization.”
 

Spine specialists at HSS have been using a 30-camera array, called 3dMD, in the lab for several years, but the new study shows that the system produces clinically meaningful information. Because 3dMD does not rely on ionizing radiation, the technology may help adolescents with scoliosis avoid many of the repeated and potentially harmful x-rays that conventional care requires.

“Determining spinal range of motion is a lot more difficult than it sounds,” said Roger Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and co-principal investigator on the new study. The conventional gold standard has been the use of x-ray imaging; however, x-ray tests are expensive, and long-term exposure to radiation from the scans has been linked to cancers.

The new technology provides a “safe, repeatable, inexpensive measurement of spinal range of motion that can be used in both a research and clinical setting,” Dr. Widmann said.

Information from the 3dMD scans can help spine surgeons determine the optimal approach to operative treatments and allow them to better track the progress of scoliosis patients following surgery. “The technology gives you objective measures of range of motion so you can improve your surgical decision-making,” Dr. Widmann said.

The HSS team presented their findings today at the 2023 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in a poster titled “3D Surface Topographic Optical Scans Yield Highly Reliable Spine Range of Motion Measurements in Adolescents.”

The 30-camera array can generate a whole-body image of a standing person in under 2 milliseconds – fast enough to eliminate any blurring from even the slightest movement in any direction.

In previous studies, the HSS team and their colleagues have shown that images generated with the ultrafast cameras match the anatomy beneath the skin. That alignment is critical for 3dMD to be useful in the clinic as a way to guide treatment for scoliosis, which affects between 2% and 3% of youth in the United States, or 6 to 9 million people.

Treatment for scoliosis frequently involves physical therapy or the use of braces to correct the curvature of the spine – a measurement called the “Cobb angle” – but in the most severe cases, surgery may be necessary.

For the new study, Dr. Widmann’s group used 3dMD to image 254 boys and girls with scoliosis and 53 without the spinal deformity as they underwent several exercises designed to work the torso in various directions.

“This is teaching us which parameters are more useful and which are not,” says Howard Hillstrom, PhD, a biomechanical engineer at HSS, senior director of the Leon Root, MD Motion Analysis Laboratory and co-principal investigator on this project.

The new study found two movements that were reliably able to differentiate youth with scoliosis from those with normal spines: bending as far to the left and right as possible while standing, and bending toward the floor as if to touch the toes.

In the first case, patients with scoliosis show significant asymmetry between one side and the other in terms of how far to each side they can bend. Meanwhile, scoliosis patients are not able to bend as far toward the floor – as measured from a point on their collarbone – as those with unaffected spines, Dr. Hillstrom said. “That’s good enough to distinguish healthy kids from those with scoliosis because most kids are so flexible they can get to the floor and those with scoliosis probably can’t.”

Although the assessments make sense both intuitively and clinically, the latest study shows that they are also an objective measure of scoliosis. The entire process, from the start of the scan to the generation of results, takes under 10 minutes, Dr. Hillstrom added.

“And now we have this system that acquires these variables and doesn’t require ionizing radiation to do so,” he said, noting that this is critically important because scoliosis patients have a significantly greater incidence of cancer, breast cancer, and cancer mortality than those without the condition – an increase many experts attribute to the radiation they receive from x-rays and CT scans.

The process of diagnosing scoliosis starts early. “The first time someone notices that a child may have scoliosis is usually when the school nurse sees it during a routine examination,” Dr. Hillstrom said. “The nurse tells the parent to take the child to a doctor, and the first thing a physician will do is order an x-ray.”

The HSS team now has imaging studies of more than 300 adolescent patients with scoliosis in its 3dMD database. “Of those, approximately 50 are a year out from surgery and 30 are two years out, providing the ability to look at the long-term benefits of the technology on range of motion and other parameters [such as angle of trunk rotation, back surface rotation, and asymmetry in lateral bending and twisting”, Dr. Widmann said. 

Authors: Alon Wolf, PhD; Ankush Thakur, MS,BS (HSS); Benjamin N. Groisser, BA, (Technion); Caroline C. Gmelich, BA; Don Li, MD,PhD; Hila Otremski, MD; Howard J. Hillstrom, PhD; Jessica H. Heyer, MD; Kira Page, BA; Kyle Morse, MD; Matthew E. Cunningham, MD, PhD, FAAOS, (HSS); Michael T. Hresko, MD,FAAOS, (Boston Children's Hospital); Roger F. Widmann, MD, FAAOS, (HSS); Ron Kimmel, DPHIL (OXON)

“We strive to provide the most advanced, comprehensive and compassionate care for our young patients and are honored to be recognized as one of the nation’s very best hospitals in pediatric orthopedics,” said Louis A. Shapiro, president and CEO of HSS. “This achievement validates the commitment of our team of pediatric specialists to provide personalized care to meet the specific needs of every patient and family.”

The annual U.S. News Best Children's Hospitals edition, now in its 16th year, offers guidance to parents seeking the best place for a child in need of expert care. Pediatric orthopedics is among 10 ranked specialties, which also include pediatric cancer and pediatric cardiology & heart surgery.

Fifty hospitals were ranked in pediatric orthopedics for the treatment of conditions such as scoliosis and spina bifida and injuries such as complex fractures or other sports injuries. Rankings are based on clinical data and on an annual survey of pediatric specialists. Factors under consideration include patient outcomes, compliance with best practices, nursing staff and resources for patients, such as services to ease the anxiety of a child’s hospital stay.

“Choosing a hospital is one of the most important decisions parents will ever make, and everyone wants what's best for their child. Our goal is to provide the highest quality, family-centered care in a supportive setting,” said Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS. “Our pediatric orthopedic surgeons are highly specialized in areas such as spine, sports medicine, hip disorders and cerebral palsy. They work alongside a team of pediatric anesthesiologists and non-surgical specialists to ensure the best and safest care.”

“We are dedicated to maintaining the highest standards in quality and safety, recognizing that a ‘one-size-fits-all’ approach does not work in health care,” said Bryan T. Kelly, MD, surgeon-in-chief and medical director at HSS. “As the leading academic medical center specialized in musculoskeletal health, we are able to offer advanced care for the most complex problems with a healing environment specifically designed for children and teenagers.”

There were over 56,000 physician visits and more than 48,000 rehabilitation visits to the HSS Lerner Children’s Pavilion last year. A low dose X-ray system that exposes patients to only 10 percent of the radiation of standard X-rays and the Leon Root, MD Motion Analysis Laboratory are among the diagnostic tools that benefit patients.

The findings, presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting, shows that the ultrafast cameras produce scans of the surface of the body that complement internal images generated by low-dose x-ray. Because 3dMD does not rely on ionizing radiation, the investigators believe the technology may help scoliosis patients avoid many of the repeated and potentially harmful x-rays that conventional care require.

Surface topography and internal imaging work together to provide a much fuller picture of how scoliosis affects the body, according to Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and the senior researcher on the study. “When you see someone with a spinal deformity, you’re not necessarily visualizing the shape of the spine underneath,” he said. “Three-dimensional (3-D) surface scanning is analogous to what you see visually, whereas x-rays or MRI are often much different from what you see on the surface. Both approaches are important, but the information they provide is quite different.”

Howard J. Hillstrom, PhD, a biomechanical engineer at HSS and co-principal investigator on the project, says the 30-camera array can generate a full image of a standing person in under two milliseconds—fast enough to eliminate any blurring from even the slightest movement in any direction. “It gives us very accurate information to begin with, and it’s important to start with sound data,” Dr. Hillstrom noted.

What was previously unknown was how well these images of the body’s surface conform to the anatomy beneath the skin. This relationship is critical for 3dMD to be useful in the clinic as a way to guide treatment for scoliosis, which affects between 2% and 3% of youth in the United States, or 6 to 9 million people.

Treatment for scoliosis frequently involves the use of braces to correct the curvature of the spine—a measurement called the Cobb angle—but in the most severe cases, surgery may be necessary.

Dr. Hillstrom, who describes the image as a “large, 3-D selfie,” said these results “give us the green flag to study spinal pathology and the effects of treatments for different severities of scoliosis” in ways that weren’t possible previously.

For clinicians, he added, “It’s great to have objective tools to support the patient-reported outcomes that we use.”

For the study, the researchers compared images gathered by 3dMD with those produced by a next-generation x-ray system called EOS. A total of 46 youths participated in the study, 26 of whom had been diagnosed with adolescent idiopathic scoliosis (mean age, 14.7 years; 14 female, 12 male) and 20 who did not have the condition (mean age, 14.6 years; 9 female, 11 male).

The 3dMD images demonstrated extremely high reliability, particularly for linear geometric measurements of the surface of the subjects. “The measurements generated from the 3-D scans were used to create unique volumetric measures of truncal asymmetry, which demonstrated very high correlations with patient-reported self-image,” Dr. Widmann said.

Dr. Hillstrom noted the post-processing software that employs artificial intelligence (AI) is the secret behind the accuracy of the camera array. “AI fills in the blanks very quickly. It helps to identify anatomical regions and provide a mathematical approach to organizing the topographic data showing you the head, neck, trunk and pelvis—from outside of the body. You can uncover details you wouldn’t normally be able to see with the naked eye or with the use of conventional radiology.”

As the 3dMD system moves into the clinic, the technology will help surgeons better predict both the cosmetic and functional outcomes of the various procedures for scoliosis. “You can use the system to assess the efficacy of different surgical techniques based on how well you’re creating symmetry of the surface of the torso,” Dr. Widmann said. “This technology offers a quick and easy way to objectively assess surface symmetry as well as global spine range of motion, and both measures are really important to assess after scoliosis surgery.”

Authors: Alon Wolf, PhD; Ankush Thakur, MS, BS, (HSS), Benjamin N. Groisser, BA (Technion), Howard J. Hillstrom, PhD (HSS), Kyle Morse, MD, Matthew E. Cunningham, MD, PhD, FAAOS (HSS), Michael T. Hresko, MD, FAAOS (Boston Children's Hospital), Roger F. Widmann, MD, FAAOS (HSS), Ron Kimmel, DPHIL (OXON).

“We are proud to provide the most advanced and comprehensive care for young patients with musculoskeletal conditions,” said Louis A. Shapiro, president and CEO of HSS. “This recognition demonstrates the commitment of our pediatric specialists to do what’s best for each patient and their family, so they can get back to what they need and love to do with confidence.”

The 15^th annual Best Children’s Hospitals rankings are the only comprehensive source of quality-related information on pediatric centers in the country. These rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as patient safety, and infection rates, as well as available clinical resources and compliance with best practices.

“When selecting a hospital for pediatric orthopedic care, safety, quality and personalized treatment are the greatest importance for families,” said Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS. “These measures remain at the center of all that we do, when diagnosing and caring for children with musculoskeletal conditions, to get them back to the activities they enjoy the most.”

Select measures driving the compilation of this year’s list where HSS performed at the forefront include:

• Adoption of Health Information Technology
• Advanced Technology
• Engagement in Research
• Commitment to Quality Improvement
• Steps to Engage Families
• Fulltime Subspecialist
• Patient and Family Services
• Nurse Staffing
• Nurse Magnet Recognition
• Specialized Clinics and Programs
• Use of Infection-preventing Measures
• Speed and Success with Complex Fractures

“HSS is focused solely on providing the safest and most advanced musculoskeletal care,” said Bryan T. Kelly, MD, surgeon-in-chief and medical director at HSS. “Our team of pediatric specialists is dedicated to performing, researching, and teaching the latest techniques and treatments for children, in a safe and healing environment.”

There were more than 44,000 pediatric visits to the HSS Lerner Children’s Pavilion to be treated by dedicated surgeons, physicians, anesthesiologists, radiologists, nurses and social workers. Its Leon Root MD, Motion Analysis Laboratory and Child Life program are among unique features.

Currently, physicians monitor patients with scoliosis — an excessive curvature of the spine — using x-rays for a period of many years. This extensive exposure to radiation can be harmful, particularly as scoliosis primarily affects young people. HSS researchers hope the results of the study will lead to an algorithm to estimate the curvature of the spine without the need for x-rays.

At the heart of the approach is a highly accurate 30 camera whole body 3D surface imaging system manufactured by 3dMD, which acquires the patients shape using stereophotogrammetry. “You can take that image, flip it upside down, slice it and dice it at any level that you want because it’s a mathematical depiction of the surface of the patient,” said Roger F. Widmann, MD, Chief of the Pediatric Orthopedic Surgery Service at HSS.

“This technology is essentially producing the world’s most advanced selfie, and the benefit is that there’s nothing dangerous about it,” said Howard J. Hillstrom, PhD, director of the Leon Root, MD Motion Analysis Laboratory at HSS and the principal investigator of the study. “When you image with this system, you can count the number of hairs on a person’s leg.”

The new study combines two recently available imaging technologies: topographical mapping using 3dMD, a proprietary system of high-resolution cameras, and EOS imaging, a dual plane x-ray machine that determines spinal alignment while significantly reducing exposure to ionizing radiation. The 3dMD system combines information from 30 high-definition cameras to produce a full map of the torso in under a second. The speed of the process is a significant advantage over conventional imaging, according to Dr. Hillstrom, who noted that up to 10 to 20 percent of torso x-rays must be redone because inadvertent movements during the scans distort the picture. “3dMD is immune to that,” he said. In conjunction with collaborators from Technion (Alon Wolf, PhD, Ron Kimmel, PhD, and Benjamin Groisser), a leading scientific university in Israel, it is the long-term goal for HSS to improve the ability of estimating spinal malalignment with a minimum amount of radiation exposure to these patients.

Scoliosis affects an estimated 6 to 9 million Americans, or roughly 2 to 3% of the population; most patients are female. The condition typically is detected when children are in elementary school, during routine screening at school or at their pediatrician’s office. If scoliosis is suspected, clinicians will try to determine the extent of the curvature — mild, moderate or severe — using x-rays. Although mild and moderate cases can improve with physical therapy and bracing, severe cases may require surgery. “Severe scoliosis starts to affect the symmetry of the thoracic cavity and might then affect lung function,” Dr. Hillstrom said.

Restoring symmetry is a primary goal of scoliosis surgery, added Dr. Widmann. However, symmetry is difficult to determine using x-rays, which don’t necessarily reveal how changes to the skeleton affect the shape of the body. “One of the most important things to patients and families is appearance,” he said. “That’s what they see and what the world sees. This technology is showing you the surface, and we hope it will help us align the goals of surgery even more closely with what patients and families want from the procedure.” Anatomical mapping could improve bracing therapy in the same way, he added.

HSS researchers also will be gathering Patient Reported Outcomes Measures (PROMs), such as mobility, personal appearance, ability to participate in sports and other aspects of daily life and more.

So far, 30 children have enrolled in the study, which Dr. Hillstrom and colleagues hope will ultimately include 2,000 patients over the next five years, as well as roughly 500 people with normal spines to serve as comparisons.

“Being able to use this technology to screen patients for scoliosis would be a big improvement over the current method, which uses a carpenter’s level on a patient’s back and has a very high rate of false-positives,” Dr. Widmann said. In other words, many children initially suspected of having scoliosis don’t have the condition — but doctors don’t know that until they take an x-ray. “You’re taking x-rays on a lot of kids who don’t need them, so we need a very reliable technology that correlates with x-rays so that you can safely decide if you need one or not. We’d love to have a better tool for this,” he adds.

The technology might also prove useful for other orthopedic applications, such as creating better casts for custom orthoses and prostheses or estimating inequality in the length of limbs — a problem that can lead to issues with gait, back pain and other complications. One medical application that combines these two technologies is cranio-fascial reconstructive surgery where both the shape of the external surface and the underlying bony architecture must be matched for proper function. But the uses are potentially much broader, Dr. Hillstrom said. “I think when you turn a group of experts loose on a new technology, they’re going to come up with a list of applications that we never dreamed of at the outset.”

Portions of the data collected from 3dMD will also be a part of a 3-year competitive research grant that was just awarded to HSS from the Cotrel Foundation entitled, “Use of Surface Topography for Screening and Outcome Evaluation of Adolescent Idiopathic Scoliosis”. Dr. Widmann serves as the principal investigator and Dr. Hillstrom as a co-investigator along with a team of pediatric Orthopedic surgeons, scientists, engineers, radiologists, pediatric sports medicine specialists, physical therapists, prosthetists/orthotists, pediatricians, and trainees.

The lower-dose imaging technology is now available at HSS Westchester in White Plains, New York. The other imaging systems are at the main hospital campus in Manhattan, including one at the Lerner Children’s Pavilion.

“Many of our pediatric patients who are treated for scoliosis need x-rays several times a year. We take every safety precaution with all imaging tests, and the low-dose system is another way we can meet the needs of our patients and provide high quality care,” noted Dr. Roger Widmann, chief of Pediatric Orthopedic Surgery at HSS.

“Parents of our Westchester and Connecticut patients have been willing to travel one or two hours to our Manhattan location for the low-dose x-rays,” he added. “The new imaging system at HSS Westchester will make it more convenient for these families.”

Vera Scavone, who lives in Armonk in Westchester County, was pleased to hear that the lower-dose imaging system is now available in White Plains. Dr. Widmann successfully treated her daughter, Grace, for scoliosis, and the new location will be more convenient for any future spine x-rays she may need.

Ms. Scavone learned about low-dose x-rays for the first time two years ago when Grace became Dr. Widmann’s patient at age 15. “I definitely felt better, since Grace needed a lot of x-rays,” recalls Ms. Scavone, who traveled to HSS in Manhattan each time x-rays were needed. “It’s absolutely reassuring for parents to know that the dosage of radiation is minimized.”

“Our goal is to provide high quality patient care. Lower-dose x-ray imaging and other cutting edge technologies enable us to do this,” said Dr. John A. Carrino, vice chairman of the Department of Radiology and Imaging at HSS.

When choosing an imaging modality to make a diagnosis and plan treatment, physicians must balance the need for accurate measurements with the need to minimize radiation, Dr. Carrino explains. This concept, known as ALARA (as low as reasonably achievable), is particularly important in children. Physicians at HSS seek to ensure that the lowest amount of radiation is used to produce images based on the patient’s size and the diagnostic task at hand.

The lower-dose imaging facility is open to anyone who has a prescription for x-rays from his or her physician. One does not need to be a patient of an HSS doctor. Lower-dose imaging is most often used for patients who have scoliosis. The system is not used to diagnose a broken bone; regular x-rays remain the gold standard if a fracture is suspected.

In addition to scoliosis, the lower-dose system is used to assess leg length discrepancies in children. These patients generally require frequent imaging tests to monitor growth, plan for surgery and determine the effectiveness of treatment. A previous study at HSS found that the lower-dose imaging system performed as well as a conventional CT scan to assess leg length.

“HSS was an early adopter in using the low-dose imaging technology and is the only hospital in the U.S. with four units,” notes Christopher Smith, administrative director of Radiology & Imaging at HSS. “The advanced imaging system is the only one available in Westchester County and the Lower Hudson Valley Region.”

Although originally acquired primarily for imaging exams in pediatric patients at HSS, the system is being used increasingly by orthopedic surgeons treating adults who need a hip or knee replacement or spine surgery. The system provides 3D frontal and side weight-bearing images that aid in pre-surgical planning.

The test takes about 25 seconds. Patients must be capable of standing still in the spacious unit and able to follow directions from an x-ray technologist. The lower-dose x-rays are generally covered by insurance.

“HSS has an esteemed team of pediatric specialists who are dedicated to providing the most comprehensive care to all our young patients in a healing environment,” said Louis A. Shapiro, president and CEO of HSS. “We are proud to provide world class care with patients as the driving force behind our mission and vision.”

The 13^th annual Best Children’s Hospitals rankings are the only comprehensive source of quality-related information on pediatric centers in the country. These rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology.

The U.S.News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

“Quality, safety and patient-centered care are of primary importance for families when choosing a hospital for pediatric orthopedic surgical care,” said Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS. “Families travel to HSS from around the U.S. and the rest of the world to obtain state of the art diagnosis, medical management and surgical treatment.”

Select measures driving the compilation of this year’s list where HSS performed at the forefront include:

• Advanced Technology
• Commitment to Quality Improvement
• Steps to Engage Families
• Patient and Family Services
• Nursing Intensity
• Nurse Magnet Recognition
• Commitment to Best Practices
• Use of Infection-preventing Measures
• Preventing Surgical Complications

“HSS performs a high volume of pediatric orthopedic surgeries each year and this acknowledgement exhibits the dedicated focus of our pediatric specialists who provide the safest and most advanced care for children,” said Todd J. Albert, MD, surgeon-in-chief and medical director at HSS. “As part of the HSS mission, it is our duty to enhance the lives of patients by keeping them at the center of all that we do.”

There were more than 37,000 pediatric visits to the HSS Lerner Children’s Pavilion to be treated by dedicated anesthesiologists, radiologists, nurses, physical therapists and social workers. Its Leon Root MD, Motion Analysis Laboratory and Child Life program are among unique features.