A digital atlas for spinal X-rays

At the National Library of Medicine (NLM) we are developing a digital atlas to serve as a reference tool for the interpretation of cervical and lumbar spine X-rays. The atlas contains representative images for four grades of severity for cervical/lumbar anterior osteophytes and disc space narrowing, and presence/absence for cervical subluxation and lumbar spondylolisthesis. A prototype version ofthe atlas has been built using images for which expert rheumatologist readers reached exact agreement in grading. The atlas functionality includes the ability to display cervical and lumbar anatomy, display of single images or multiple simultaneous images, image processing functions, and capability to add user-defmed images to the atlas. Images are selected for display by the user specifying feature and grade (example: 'anterior osteophytes, grade 2"). Currently, the atlas runs on a Sun SPARC workstation under the Solaris operating system. The initial use of the atlas is to aid in reading a collection of 17,000 NHANES II digitized X-rays. The atlas may also be used as a general digital reference tool for the standardized interpretation of digital X-rays for osteoarthritis. We are investigating further development of the atlas to accommodate a wider set of images, to operate on multiple platforms, and to be accessible via the World Wide Web.