Cobb Angle Measurement Decision Support System of Radiography Images in Patients with Idiopathic Scoliosis
Iranian Journal of Radiology
The use of telemedicine has received considerable attention in recent decades and it has partaken different applications such as teleradiology, telepathology, remote surgery, and so on. Telemedicine has been an approach with broad publications and a technology adopted by broad categories of healthcare users. The use of new technologies at each stage of teleradiology creates new challenges. Like any system, the lifecycle of the system development from production to maintenance requires actions
... take. Methods: Based on the PRISMA checklist, a robust search strategy was developed to identify all available studies meeting the inclusion and exclusion criteria. A literature search was conducted in March 2018 for a week for searching in PubMed/ MEDLINE, Scopus, and Web of Science. We excluded articles published before 2000, non-English articles, all kinds of reviews, conference papers without full texts, notes and news, books, letters to editors, gray literature, authors' opinion, educational materials, and ad hoc implementation in the technical scope. All full-text literature in English concerning the assessment, evaluation, patient outcome, economics, and managerial aspects with a local or wide implementation in the form of original articles and case studies were included in this review. Then, data were imported into an Excel file. Results: The articles were published between January 2000 and October 2018. A full, deep review revealed that most articles were related to the hospital environment. The financial evaluations comprised cost-effectiveness, cost prediction, initial cost reduction, and plummeting transporta- Abstract Background: Scoliosis is a three-dimensional deformity of the spine that is commonly assessed through measuring the Cobb angle. Objectives: In this study, a Cobb angle measurement decision support system (CaMDSS) was presented to provide a repeatable and reproducible procedure for Cobb angle measurement in idiopathic scoliosis patients. Methods: We used the OpenCV and the Numpy library for image processing and system design. A series of 98 anterior-posterior radiographs from patients diagnosed with idiopathic scoliosis were used to assess the repeatability and reproducibility of CaMDSS. Five independent observers performed the measurements, and each image was analyzed by each observer three times with a minimum interval of two weeks between measurements. Both the intra-and inter-observer reliability were obtained using the single measure intraclass correlation coefficient (ICC) value. The mean absolute difference (MAD) and the standard error measurement (SEM) were calculated for all corresponding intra-and inter-observer reliability estimates. Results: Statistical results for the inter-observer analysis showed that the MAD between manual and CaMDSS was less than 3º, and the ICCs ranged from 0.94 to 0.99. The combined SEM between all five observers for intra-observer measurements of the manual method and CaMDSS was 1.79º and 1.27º, respectively. The inter-observer reliability of CaMDSS was excellent as the ICC value of 0.97 with 95% CI was obtained. The CaMDSS mean absolute difference was 2.18 ± 2.01 degrees. Conclusion: Our study showed CaMDSS was an efficient and reliable method to assess the scoliotic curvature in Thoraco-Lumbar standing radiographs with the possibility of expediting clinic visits, ensuring the reliability of calculation, and decreasing the patient's exposure to radiation.