title: Reliability assessment of Cobb angle measurements using manual and digital methods.
abstract: BACKGROUND
  The vertebral spine angle in the frontal plane is an important parameter in the assessment of scoliosis and may be obtained from panoramic X-ray images. Technological advances have allowed for an increased use of digital X-ray images in clinical practice.
  
  
  OBJECTIVE
  In this context, the objective of this study is to assess the reliability of computer-assisted Cobb angle measurements taken from digital X-ray images.
  
  
  METHODS
  Clinical investigation quantifying scoliotic deformity with Cobb method to evaluate the intra- and interobserver variability using manual and digital techniques.
  
  
  METHODS
  Forty-nine patients diagnosed with idiopathic scoliosis were chosen based on convenience, without predilection for gender, age, type, location, or magnitude of the curvature.
  
  
  METHODS
  Images were examined to evaluate Cobb angle variability, end plate selection, as well as intra- and interobserver errors.
  
  
  METHODS
  Specific software was developed to digitally reproduce the Cobb method and calculate semiautomatically the degree of scoliotic deformity. During the study, three observers estimated the Cobb angle using both the digital and the traditional manual methods.
  
  
  RESULTS
  The results showed that Cobb angle measurements may be reproduced in the computer as reliably as with the traditional manual method, in similar conditions to those found in clinical practice.
  
  
  CONCLUSIONS
  The computer-assisted method (digital method) is clinically advantageous and appropriate to assess the scoliotic curvature in the frontal plane using Cobb method.
authors.affiliation: Medical School, University of São Paulo, Ribeirão Preto, Brazil 14.049-900. mitanure@usp.br
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Tanure
authors.forename: Alan P
authors.initials: AP
authors.lastname: Pinheiro
authors.forename: Anamaria S
authors.initials: AS
authors.lastname: Oliveira
mesh_terms: D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D011859:Radiography / Q000379:methods*; D015203:Reproducibility of Results; D012600:Scoliosis / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging