title: Semiautomatic superimposition improves radiological assessment of curve flexibility in scoliosis.
abstract: OBJECTIVE
  Assessment of scoliotic curve flexibility and stiffness is essential for planning surgical treatment in adolescent idiopathic scoliosis (AIS). Measurement of curve flexibility is currently insufficiently precise. The purpose of this study was to introduce and validate a novel method of superimposing radiographs for more reliable measurement of curve flexibility.
  
  
  METHODS
  Two independent radiologists measured Cobb angles separately on standard anterior-posterior (AP) (n = 48) and supine bending radiographs (n = 48), in patients with AIS, who were randomly included from a surgical database. The same readers repeated the measurements after the bending radiographs were semi-automatically superimposed on the AP radiographs by fusing the caudad end vertebra. Curve flexibility was calculated. Inter-reader agreement between the two independent readers was calculated using interclass correlation coefficient (ICC).
  
  
  RESULTS
  A moderate inter-reader agreement was achieved in the upper curve (ICC = 0.57) and a good agreement in the lower curve (ICC = 0.72) with the standard method of assessing curve flexibility. With the use of the semiautomatic superimposition, however, almost perfect agreement was achieved for both the upper and the lower curves flexibilities (ICC = 0.93 and 0.97, respectively).
  
  
  CONCLUSIONS
  The introduced semi-automatic superimposition technique for measurement of scoliotic curve flexibility in AIS is more precise and reliable than the current standard method.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland, nadja.farshad@usz.ch.
authors.forename: Nadja A
authors.initials: NA
authors.lastname: Farshad-Amacker
authors.forename: T D
authors.initials: TD
authors.lastname: Nguyen
authors.forename: M
authors.initials: M
authors.lastname: Farshad
authors.forename: G
authors.initials: G
authors.lastname: Andreisek
authors.forename: K
authors.initials: K
authors.lastname: Min
authors.forename: T
authors.initials: T
authors.lastname: Frauenfelder
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D011871:Radiology / Q000592:standards; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013131:Spine / Q000000981:diagnostic imaging