Validity and Absolute Reliability of the Cobb Angle in Idiopathic Scoliosis with TraumaMeter Software

Abstract

The Cobb angle value is a critical parameter for evaluating adolescent idiopathic scoliosis (AIS) patients. This study aimed to evaluate a software’s validity and absolute reliability to determine the Cobb angle in AIS digital X-rays, with two different degrees of experienced observers. Four experts and four novice evaluators measured 35 scoliotic curves with the software on three separate occasions, one month apart. The observers re-measured the same radiographic studies on three separate occasions three months later but on conventional X-ray films. The differences between the mean bias errors (MBE) within the experience groups were statistically significant between the experts (software) and novices (manual) (p < 0.001) and between the novices (software) and novices (manual) (p = 0.005). When measured with the software, the intra-group error in the expert group was MBE = 1.71 ± 0.61° and the intraclass correlation coefficient (ICC (2,1)) = 0.986, and in the novice group, MBE = 1.9 ± 0.67° and ICC (2,1) = 0.97. There was almost a perfect concordance among the two measurement methods, ICC (2,1) = 0.998 and minimum detectable change (MCD95) < 0.4°. Control of the intrinsic error sources enabled obtaining inter- and intra-observer MDC95 < 0.5° in the two experience groups and with the two measurement methods. The computer-aided software TraumaMeter increases the validity and reliability of Cobb angle measurements concerning manual measurement.

A fresh look at spinal alignment and deformities: Automated analysis of a large database of 9832 biplanar radiographs

“…While the version of the deep learning model used in this paper includes several improvements with respect to the original version (Galbusera et al, 2019) and was trained on a larger dataset, some degree of error in the localization of the landmarks cannot be excluded especially in the case of major deformities, as documented in the validation against human raters. Such results should be evaluated accounting for the relative lack of reliability of measurements performed by humans; indeed, considering the Cobb angle of scoliosis as a reference, an average error of 3.7-7.2 °when using manual tools (Morrissy et al, 1990;Wang et al, 2018) and of 1.7-1.9 °with computeraided systems (Hurtado-Avilés et al, 2022) were reported, demonstrating that further improvements are necessary prior to a generalized clinical use of automated measurement systems. Finally, as mentioned above detailed statistical analyses addressing specific research questions were not conducted, since this paper aimed at presenting the dataset in a descriptive form with a methodological focus on the deep learning technique used for the evaluation of the images.…”

Spine Deformity Assessment for Scoliosis Diagnostics Utilizing Image Processing Techniques: A Systematic Review

“…The instrumentation or imaging modality is crucial in capturing the structure of the spine to obtain good image quality because it affects the accuracy of scoliosis diagnosis. Six out of eighteen studies used common and conventional imaging modalities, such as X-rays, computed tomography (CT), and ultrasounds [18][19][20]28,33,34], while other researchers [21][22][23][24][25][26][27][29][30][31]35] used uncommon instrumentation, like rasterstereography, cameras, EOS imaging, scanners, and 3D laser profilemeters. Special mention goes to Sikidar et al [32], as the study did not collect data as images that used electromyogram (EMG) and ground reaction force (GRF) data.…”

“…The sources of the data can be categorized into two, which are the patients and images. Most of the articles used subjects that were patients to obtain images, and only four articles [18][19][20][21] used solely readily images as their dataset. Three studies used private datasets, and one paper did not state the source of the dataset.…”

SOX9 gene shows association with adolescent idiopathic scoliosis predisposition in Northwest Indians

“…Additionally, clinically diagnosed samples were recruited in the study from the All India Institute of Medical Sciences, New Delhi. All the cases were clinically diagnosed based on the Cobb angle measurement [16,17]. The inclusion criteria for the cases were based on a Cobb angle measurement of 10° or greater.…”