Dedicated Spine Measurement Software Quantifies Key Spino-Pelvic Parameters More Reliably Than Traditional Picture Archiving and Communication Systems Tools

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-LLP