Document Type : Original Article

Authors

1 Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Scoliosis is the most common type of spinal deformity. A universal 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.

Keywords

  1. Adam C, Dougherty G. Applications of medical image processing in the diagnosis and treatment of spinal deformity. Medical Image Processing: Springer; 2011. p. 227-48.
  2. Herring JA. Tachdjian’s Pediatric Orthopaedics E-Book: From the Texas Scottish Rite Hospital for Children: Elsevier Health Sciences; 2013.
  3. Asher MA, Strippgen WE, Heinig CF, Carson WL. Isola spinal implant system. Semin Spine Surg. 1992;4:175-81.
  4. Jaeger U, Koenig R, Gieseke J, Wagner U, Kandyba J, Ostertun B, editors. MR total spine projection in juvenile scoliosis: an alternative to radiographic follow-up. Radiology; 1998: RADIOLOGICAL SOC NORTH AMER 20TH AND NORTHAMPTON STS, EASTON, PA 18042 USA.
  5. Gstoettner M, Sekyra K, Walochnik N, Winter P, Wachter R, Bach CM. Inter- and intraobserver reliability assessment of the Cobb angle: manual versus digital measurement tools. Eur Spine J. 2007;16:1587-92. doi.org/10.1007/s00586-007-0401-3. PubMed PMID: 17549526. PubMed PMCID: 2078306.
  6. Allen S, Parent E, Khorasani M, Hill DL, Lou E, Raso JV. Validity and reliability of active shape models for the estimation of cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging. 2008;21:208-18. doi.org/10.1007/s10278-007-9026-7. PubMed PMID: 17340228. PubMed PMCID: 3043859.
  7. Kuklo TR, Potter BK, Polly DW, Jr., O’Brien MF, Schroeder TM, Lenke LG. Reliability analysis for manual adolescent idiopathic scoliosis measurements. Spine (Phila Pa 1976). 2005;30:444-54. doi.org/10.1097/01.brs.0000153702.99342.9c. PubMed PMID: 15706343.
  8. Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH. Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am. 1990;72:320-7. doi.org/10.2106/00004623-199072030-00002. PubMed PMID: 2312527.
  9. Konig R, Jaeger U, Ostertun B, Kandyba J, Wagner U, Gieseke J, et al. MR whole-spine recording: computer-assisted simulation of the conventional x-ray technic. Rofo. 1999;170:258-61. doi.org/10.1055/s-2007-1011037. PubMed PMID: 10230434.
  10. Kundu R, Chakrabarti A, Lenka PK. Cobb angle measurement of scoliosis with reduced variability. arXiv preprint arXiv:1211.5355. 2012.
  11. Jeffries BF, Tarlton M, De Smet AA, Dwyer SJ, 3rd, Brower AC. Computerized measurement and analysis of scoliosis: a more accurate representation of the shape of the curve. Radiology. 1980;134:381-5. doi.org/10.1148/radiology.134.2.6986054. PubMed PMID: 6986054.
  12. Shea KG, Stevens PM, Nelson M, Smith JT, Masters KS, Yandow S. A comparison of manual versus computer-assisted radiographic measurement. Intraobserver measurement variability for Cobb angles. Spine (Phila Pa 1976). 1998;23:551-5. doi.org/10.1097/00007632-199803010-00007. PubMed PMID: 9530786.
  13. Carman DL, Browne RH, Birch JG. Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am. 1990;72:328-33. doi.org/10.2106/00004623-199072030-00003. PubMed PMID: 2312528.
  14. Chockalingam N, Dangerfield PH, Giakas G, Cochrane T, Dorgan JC. Computer-assisted Cobb measurement of scoliosis. Eur Spine J. 2002;11:353-7. doi.org/10.1007/s00586-002-0386-x. PubMed PMID: 12193997. PubMed PMCID: 3610477.
  15. Rosenfeldt MP, Harding IJ, Hauptfleisch JT, Fairbank JT. A comparison of traditional protractor versus Oxford Cobbometer radiographic measurement: intraobserver measurement variability for Cobb angles. Spine (Phila Pa 1976). 2005;30:440-3. doi.org/10.1097/01.brs.0000153401.78638.cb. PubMed PMID: 15706342.
  16. Zhang J, Lou E, Le LH, Hill DL, Raso JV, Wang Y. Automatic Cobb measurement of scoliosis based on fuzzy Hough Transform with vertebral shape prior. J Digit Imaging. 2009;22:463-72. doi.org/10.1007/s10278-008-9127-y. PubMed PMID: 18516643. PubMed PMCID: 3043716.
  17. Omoto E, Wakamatsu O, Sanada S, Tokyo JP, Kanazawa JP. Development of software for automatic measurement of Cobb angle and quantitative assessment method for followup in radiographs of patients with scoliosis. European Society of Radiology. Vienna: Austria; 2009.
  18. Tanure MC, Pinheiro AP, Oliveira AS. Reliability assessment of Cobb angle measurements using manual and digital methods. Spine J. 2010;10:769-74. doi.org/10.1016/j.spinee.2010.02.020. PubMed PMID: 20359959.
  19. Kundu R, Lenka P, Kumar R, Chakrabarti A. Cobb angle quantification for scoliosis using image processing techniques. Proceedings of the International Journal of Computer Applications. 2012:6-11.
  20. Behrenbruch CP, Petroudi S, Bond S, Declerck JD, Leong FJ, Brady JM. Image filtering techniques for medical image post-processing: an overview. Br J Radiol. 2004;77 Spec No 2:S126-32. doi.org/10.1259/bjr/17464219. PubMed PMID: 15677354.
  21. Duong L, Cheriet F, Labelle H. Automatic detection of scoliotic curves in posteroanterior radiographs. IEEE Trans Biomed Eng. 2010;57:1143-51. doi.org/10.1109/TBME.2009.2037214. PubMed PMID: 20142161.
  22. Gonzalez RC, Woods RE. Digital Image Processing. 4th edition. New York, NY: Pearson; 2017.