and standard method for evaluating scoliosis is Cobb Angle measurement, but several studies have shown that there is intra-and inter-observer variation in measuring Cobb Angle manually. Objective: Develop a computer-assisted system to decrease operator-dependent errors in Cobb Angle measurement. Methods: The spinal cord in the given x-ray image of the spine is highlighted using contract-stretching technique. The overall structural curvature of the spine is determined by a semi-automatic algorithm aided by the operator. Once the morphologic curve of the spine is determined, in the last step the Cobb-Angle is estimated by calculating the Angle between two normal lines to the spinal curve at the inflection points of the curve. Results: Evaluation results of the developed algorithms using 14 radiographs of patients (4-40 years old) with Cobb Angle ranges from 34-82 degrees, revealed that the developed algorithm accurately estimated Cobb Angle. Statistical analysis showed that average Angle values estimated using the developed method and that provided by experts are statistically equal. The correlation coefficient between the Angle values estimated using the developed algorithm and those provided by the expert is 0. 81. Conclusion: Compared with previous algorithms, the developed system is easy to use, less operator-dependent, accurate, and reliable. The obtained results are promising and show that the developed computer-based system could be used to quantify scoliosis by measuring Cobb Angle.

Background: One of the spine deformities is scoliosis, and Cobb Angle is generally used to assess it. Objectives: In this study, a computer-aided measurement system (CAMS) was presented as a new repeatable and reproducible approach to assess the Cobb Angle in idiopathic scoliosis patients. Methods: Python libraries, including OpenCV and Numpy were used for image processing and design of the software. To assess the repeatability and reproducibility of the CAMS, a series of 98 anterior-posterior radiographs from patients with idiopathic scoliosis were used. Assessments were done by five independent observers. Each radiograph was assessed by each observer three times with a minimum break of two weeks among assessment. The single measure intraclass correlation coefficient (ICC), the mean absolute difference (MAD), and the standard error measurement (SEM) values were used for intra-and inter-observer reliability. Results: The inter-observer analysis indicated that the ICCs ranged from 0. 94-0. 99, and the MAD between manual and CAMS were less than 3°, . For intra-observer measurements, the combined SEM between all observers for the manual and CAMS was 1. 79°,and 1. 27°, , respectively. An ICC value of 0. 97 with 95% confi, dence interval (CI) was excellent in CAMS for inter-observer reliability. The MAD of CAMS was 2. 18 ,2. 01 degrees. Conclusions: The CAMS is an effective and reliable approach for assessing scoliotic curvature in the standing radiographs of thoraco-lumbar. Moreover, CAMS can accelerate clinical visits, and its calculation results are reliable.

Introduction: Scoliosis is a musculoskeletal disorder in which a person's spine bends sideways and rotates along its vertical axis. Cobb-Angle (CA) is a common index to evaluate, determine, and track the progression of scoliosis,however, measuring this index manually depends on the operator’, s experience and image quality, which may lead to errors, dispersion of obtained values, and variability. This study aimed to resolve this issue by developing an algorithm for measuring CA. Methods: In this analytical study, we developed software using image processing, data modeling, and analytical geometry tools for measuring CA. A given x-ray image was processed to highlight the spinal cord. Then, the spinal cord curvature was extracted by manually segmenting the spinal cord in the given image and fitting a polynomial function to the data points in the identified region. Finally, CA was estimated by calculating the Angle between the two normal lines that pass through the inflection points of the fitted curve. Thirty X-ray images having CA values obtained by an expert were used to evaluate the accuracy of the developed algorithm. Results: There is no statistically significant difference between the average CA values measured by the expert (53. 95º,±,20. 3º, ) and those estimated using the developed software (56. 41º,±,19. 95º, ). There is a significant correlation between the values estimated using the developed algorithm and the reference values, (r=0. 93) and (P<10-8). Conclusion: The obtained results are promising and show that the developed algorithm might be used to measure Cobb-Angle. Nevertheless, its accuracy and reliability should be further evaluated using a large data set.