title: Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system.
abstract: BACKGROUND
  Three-dimensional (3D) deformations of the spine are predominantly characterized by two-dimensional (2D) angulation measurements in coronal and sagittal planes, using anteroposterior and lateral X-ray images. For coronal curves, a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice, and these methods have been shown to exhibit good-to-excellent reliability and reproducibility, carried out either manually or by computer-based tools. Recently, an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column.
  
  
  OBJECTIVE
  Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting.
  
  
  METHODS
  Retrospective nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009.
  
  
  METHODS
  In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4° and 117.5°. Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation: 0° to 10° (Group 1, n=36), 10° to 25° (Group 2, n=25), 25° to 50° (Group 3, n=69), 50° to 75° (Group 4, n=49), and more than 75° (Group 5, n=22).
  
  
  METHODS
  Coronal and sagittal curvature measurements were determined by three experienced examiners, using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions. Manual measurements were performed three times, and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software (IBM Corp., Armonk, NY, USA). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.
  
  
  RESULTS
  In comparison with manual 2D methods, only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations.
  
  
  CONCLUSIONS
  This is the first clinical report on EOS 2D/3D system (EOS Imaging, Paris, France) and its sterEOS 3D software, documenting an excellent capability for accurate, reliable, and reproducible spinal curvature measurements.
authors.affiliation: Department of Orthopedic Surgery, Institute of Musculoskeletal Surgery, University of Pécs Clinical Center, 1 Akác utca, Pécs H-7632, Hungary. szabolcs.somoskeoy@aok.pte.hu
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Somoskeöy
authors.forename: Miklós
authors.initials: M
authors.lastname: Tunyogi-Csapó
authors.forename: Csaba
authors.initials: C
authors.lastname: Bogyó
authors.forename: Tamás
authors.initials: T
authors.lastname: Illés
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008953:Models, Anatomic; D015588:Observer Variation; D057285:Precision Medicine; D011859:Radiography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D013121:Spinal Curvatures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055815:Young Adult