Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools

Munish Gupta, Jensen K. Henry, Frank Schwab, Eric Otto Klineberg, Justin S. Smith, Jeffrey Gum, David W. Polly, Barthelemy Liabaud, Bassel G. Diebo, D. Kojo Hamilton, Robert Eastlack, Peter G. Passias, Douglas Burton, Themistocles Protopsaltis, Virginie Lafage

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Study Design. Measurement reliability study of adult spinal deformity (ASD) patient radiographs using intraclass correlation coefficients (ICC) and variance. Objective. The aim of the study was to compare picture archiving and communication systems (PACS) to dedicated spine measurement software (SMS). Summary of Background Data. Accurate radiographic measurement of sagittal alignment is essential for evaluating ASD. PACS measurements often necessitate rudimentary techniques and estimations of anatomic landmarks and angles. Though SMS has been studied and validated, no studies directly compare PACS to SMS. Methods. Eleven independent observers (7 spine surgeons, 4 researchers) digitally measured 20 ASD radiographs for pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), and sagittal vertical axis (SVA). Round 1 used PACS basic line/angle tools; Round 2 used a validated SMS that automatically calculates spino-pelvic parameters from 6 user-identified landmarks. Means, coefficient of variance (CV), and intraclass correlation coefficients (ICC) were analyzed. Results. PACS measurements were significantly greater than SMS (PI, PT, PI-LL: P<0.0001), though within clinical and measurement margins of error. Excluding TK, the variations in measurement (CV) were significantly greater for PACS (14-34%) vs. SMS (11-23%). Reliability was greater in SMS than PACS for PI, PT, PI-LL, LL, and SVA. The greatest differences in intraclass correlation coefficients (ICC) between PACS and SMS were in PI (PACS: 0.647; SMS: 0.810) and PI-LL (PACS: 0.921; SMS: 0.970). Among surgeons, the differences between PACS and SMS were augmented, and SMS had higher intraclass correlation coefficients (ICC) than PACS for all parameters (mean intraclass correlation coefficients [ICC] 0.931 vs. 0.861). Among surgeons, PI had the lowest reliability (PACS: 0.505; SMS: 0.752) and SVA had the highest (PACS: 0.985; SMS: 0.994). Conclusion. SMS provides significantly more reliable measurements than PACS, especially among surgeons. Consistent use of SMS in the evaluation and surgical planning of ASD patients appears necessary given the significant differences in values, variance, and reliability between PACS and SMS.

Original languageEnglish (US)
Pages (from-to)E22-E27
JournalSpine
Volume41
Issue number1
DOIs
StatePublished - 2016

Fingerprint

Radiology Information Systems
Spine
Software
Lordosis
Incidence
Kyphosis
Thorax
Anatomic Landmarks

Keywords

  • Alignment
  • Computerized
  • Digitized
  • Intraclass correlation coefficients (ICC)
  • Measurement
  • Observer
  • Parameters
  • Radiographic
  • Reliability
  • Sagittal alignment
  • Spine measurement
  • Spino-pelvic
  • Variation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools. / Gupta, Munish; Henry, Jensen K.; Schwab, Frank; Klineberg, Eric Otto; Smith, Justin S.; Gum, Jeffrey; Polly, David W.; Liabaud, Barthelemy; Diebo, Bassel G.; Kojo Hamilton, D.; Eastlack, Robert; Passias, Peter G.; Burton, Douglas; Protopsaltis, Themistocles; Lafage, Virginie.

In: Spine, Vol. 41, No. 1, 2016, p. E22-E27.

Research output: Contribution to journalArticle

Gupta, M, Henry, JK, Schwab, F, Klineberg, EO, Smith, JS, Gum, J, Polly, DW, Liabaud, B, Diebo, BG, Kojo Hamilton, D, Eastlack, R, Passias, PG, Burton, D, Protopsaltis, T & Lafage, V 2016, 'Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools', Spine, vol. 41, no. 1, pp. E22-E27. https://doi.org/10.1097/BRS.0000000000001216
Gupta, Munish ; Henry, Jensen K. ; Schwab, Frank ; Klineberg, Eric Otto ; Smith, Justin S. ; Gum, Jeffrey ; Polly, David W. ; Liabaud, Barthelemy ; Diebo, Bassel G. ; Kojo Hamilton, D. ; Eastlack, Robert ; Passias, Peter G. ; Burton, Douglas ; Protopsaltis, Themistocles ; Lafage, Virginie. / Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools. In: Spine. 2016 ; Vol. 41, No. 1. pp. E22-E27.
@article{401f68a9da8b4d369ddb46ba288b1c68,
title = "Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools",
abstract = "Study Design. Measurement reliability study of adult spinal deformity (ASD) patient radiographs using intraclass correlation coefficients (ICC) and variance. Objective. The aim of the study was to compare picture archiving and communication systems (PACS) to dedicated spine measurement software (SMS). Summary of Background Data. Accurate radiographic measurement of sagittal alignment is essential for evaluating ASD. PACS measurements often necessitate rudimentary techniques and estimations of anatomic landmarks and angles. Though SMS has been studied and validated, no studies directly compare PACS to SMS. Methods. Eleven independent observers (7 spine surgeons, 4 researchers) digitally measured 20 ASD radiographs for pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), and sagittal vertical axis (SVA). Round 1 used PACS basic line/angle tools; Round 2 used a validated SMS that automatically calculates spino-pelvic parameters from 6 user-identified landmarks. Means, coefficient of variance (CV), and intraclass correlation coefficients (ICC) were analyzed. Results. PACS measurements were significantly greater than SMS (PI, PT, PI-LL: P<0.0001), though within clinical and measurement margins of error. Excluding TK, the variations in measurement (CV) were significantly greater for PACS (14-34{\%}) vs. SMS (11-23{\%}). Reliability was greater in SMS than PACS for PI, PT, PI-LL, LL, and SVA. The greatest differences in intraclass correlation coefficients (ICC) between PACS and SMS were in PI (PACS: 0.647; SMS: 0.810) and PI-LL (PACS: 0.921; SMS: 0.970). Among surgeons, the differences between PACS and SMS were augmented, and SMS had higher intraclass correlation coefficients (ICC) than PACS for all parameters (mean intraclass correlation coefficients [ICC] 0.931 vs. 0.861). Among surgeons, PI had the lowest reliability (PACS: 0.505; SMS: 0.752) and SVA had the highest (PACS: 0.985; SMS: 0.994). Conclusion. SMS provides significantly more reliable measurements than PACS, especially among surgeons. Consistent use of SMS in the evaluation and surgical planning of ASD patients appears necessary given the significant differences in values, variance, and reliability between PACS and SMS.",
keywords = "Alignment, Computerized, Digitized, Intraclass correlation coefficients (ICC), Measurement, Observer, Parameters, Radiographic, Reliability, Sagittal alignment, Spine measurement, Spino-pelvic, Variation",
author = "Munish Gupta and Henry, {Jensen K.} and Frank Schwab and Klineberg, {Eric Otto} and Smith, {Justin S.} and Jeffrey Gum and Polly, {David W.} and Barthelemy Liabaud and Diebo, {Bassel G.} and {Kojo Hamilton}, D. and Robert Eastlack and Passias, {Peter G.} and Douglas Burton and Themistocles Protopsaltis and Virginie Lafage",
year = "2016",
doi = "10.1097/BRS.0000000000001216",
language = "English (US)",
volume = "41",
pages = "E22--E27",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Dedicated spine measurement software quantifies key spino-pelvic parameters more reliably than traditional picture archiving and communication systems tools

AU - Gupta, Munish

AU - Henry, Jensen K.

AU - Schwab, Frank

AU - Klineberg, Eric Otto

AU - Smith, Justin S.

AU - Gum, Jeffrey

AU - Polly, David W.

AU - Liabaud, Barthelemy

AU - Diebo, Bassel G.

AU - Kojo Hamilton, D.

AU - Eastlack, Robert

AU - Passias, Peter G.

AU - Burton, Douglas

AU - Protopsaltis, Themistocles

AU - Lafage, Virginie

PY - 2016

Y1 - 2016

N2 - Study Design. Measurement reliability study of adult spinal deformity (ASD) patient radiographs using intraclass correlation coefficients (ICC) and variance. Objective. The aim of the study was to compare picture archiving and communication systems (PACS) to dedicated spine measurement software (SMS). Summary of Background Data. Accurate radiographic measurement of sagittal alignment is essential for evaluating ASD. PACS measurements often necessitate rudimentary techniques and estimations of anatomic landmarks and angles. Though SMS has been studied and validated, no studies directly compare PACS to SMS. Methods. Eleven independent observers (7 spine surgeons, 4 researchers) digitally measured 20 ASD radiographs for pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), and sagittal vertical axis (SVA). Round 1 used PACS basic line/angle tools; Round 2 used a validated SMS that automatically calculates spino-pelvic parameters from 6 user-identified landmarks. Means, coefficient of variance (CV), and intraclass correlation coefficients (ICC) were analyzed. Results. PACS measurements were significantly greater than SMS (PI, PT, PI-LL: P<0.0001), though within clinical and measurement margins of error. Excluding TK, the variations in measurement (CV) were significantly greater for PACS (14-34%) vs. SMS (11-23%). Reliability was greater in SMS than PACS for PI, PT, PI-LL, LL, and SVA. The greatest differences in intraclass correlation coefficients (ICC) between PACS and SMS were in PI (PACS: 0.647; SMS: 0.810) and PI-LL (PACS: 0.921; SMS: 0.970). Among surgeons, the differences between PACS and SMS were augmented, and SMS had higher intraclass correlation coefficients (ICC) than PACS for all parameters (mean intraclass correlation coefficients [ICC] 0.931 vs. 0.861). Among surgeons, PI had the lowest reliability (PACS: 0.505; SMS: 0.752) and SVA had the highest (PACS: 0.985; SMS: 0.994). Conclusion. SMS provides significantly more reliable measurements than PACS, especially among surgeons. Consistent use of SMS in the evaluation and surgical planning of ASD patients appears necessary given the significant differences in values, variance, and reliability between PACS and SMS.

AB - Study Design. Measurement reliability study of adult spinal deformity (ASD) patient radiographs using intraclass correlation coefficients (ICC) and variance. Objective. The aim of the study was to compare picture archiving and communication systems (PACS) to dedicated spine measurement software (SMS). Summary of Background Data. Accurate radiographic measurement of sagittal alignment is essential for evaluating ASD. PACS measurements often necessitate rudimentary techniques and estimations of anatomic landmarks and angles. Though SMS has been studied and validated, no studies directly compare PACS to SMS. Methods. Eleven independent observers (7 spine surgeons, 4 researchers) digitally measured 20 ASD radiographs for pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), and sagittal vertical axis (SVA). Round 1 used PACS basic line/angle tools; Round 2 used a validated SMS that automatically calculates spino-pelvic parameters from 6 user-identified landmarks. Means, coefficient of variance (CV), and intraclass correlation coefficients (ICC) were analyzed. Results. PACS measurements were significantly greater than SMS (PI, PT, PI-LL: P<0.0001), though within clinical and measurement margins of error. Excluding TK, the variations in measurement (CV) were significantly greater for PACS (14-34%) vs. SMS (11-23%). Reliability was greater in SMS than PACS for PI, PT, PI-LL, LL, and SVA. The greatest differences in intraclass correlation coefficients (ICC) between PACS and SMS were in PI (PACS: 0.647; SMS: 0.810) and PI-LL (PACS: 0.921; SMS: 0.970). Among surgeons, the differences between PACS and SMS were augmented, and SMS had higher intraclass correlation coefficients (ICC) than PACS for all parameters (mean intraclass correlation coefficients [ICC] 0.931 vs. 0.861). Among surgeons, PI had the lowest reliability (PACS: 0.505; SMS: 0.752) and SVA had the highest (PACS: 0.985; SMS: 0.994). Conclusion. SMS provides significantly more reliable measurements than PACS, especially among surgeons. Consistent use of SMS in the evaluation and surgical planning of ASD patients appears necessary given the significant differences in values, variance, and reliability between PACS and SMS.

KW - Alignment

KW - Computerized

KW - Digitized

KW - Intraclass correlation coefficients (ICC)

KW - Measurement

KW - Observer

KW - Parameters

KW - Radiographic

KW - Reliability

KW - Sagittal alignment

KW - Spine measurement

KW - Spino-pelvic

KW - Variation

UR - http://www.scopus.com/inward/record.url?scp=84952987637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952987637&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000001216

DO - 10.1097/BRS.0000000000001216

M3 - Article

C2 - 26571173

AN - SCOPUS:84952987637

VL - 41

SP - E22-E27

JO - Spine

JF - Spine

SN - 0362-2436

IS - 1

ER -