Reliability assessment of Cobb angle measurements using manual and digital methods

Background contextThe 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.PurposeIn this context, the objective of this study is to assess the reliability of computer-assisted Cobb angle measurements taken from digital X-ray images.Study design/settingClinical investigation quantifying scoliotic deformity with Cobb method to evaluate the intra- and interobserver variability using manual and digital techniques.Patient sampleForty-nine patients diagnosed with idiopathic scoliosis were chosen based on convenience, without predilection for gender, age, type, location, or magnitude of the curvature.Outcome measuresImages were examined to evaluate Cobb angle variability, end plate selection, as well as intra- and interobserver errors.MethodsSpecific 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.ResultsThe 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.ConclusionsThe computer-assisted method (digital method) is clinically advantageous and appropriate to assess the scoliotic curvature in the frontal plane using Cobb method.