Spine X-ray

What it does

Spine X-ray reads cervical, thoracic, lumbar and standing whole-spine radiographs, frontal and lateral. The run locates each vertebra, then reports coronal alignment, vertebral body height, sagittal balance and slip between levels, with the landmarks it measured from drawn on the image.

Two problems drive it. Osteoporotic vertebral fractures are under-reported on routine spine and chest films, and they change treatment. Manual Cobb and sagittal measurements are slow and vary by about five degrees between readers; the run measures each curve and parameter from landmarks drawn on the image, the same way on every follow-up film.

Intended use

Decision support for the reader of a spine film: a scoliosis or deformity measurement for the spine surgeon, a fracture check for the GP or radiologist reading a lateral thoracolumbar view, and a slip grade for back-pain work-up. Every measurement carries the landmarks it was measured from.

Who it is for

Radiologists, orthopaedic and spine surgeons, paediatric scoliosis clinics, osteoporosis services and GPs. Developers can add automated Cobb angles or vertebral fracture screening to a PACS or surgical-planning workflow through the API.

Accepted input

• DICOM CR or DX radiographs of the cervical, thoracic or lumbar spine, AP and/or lateral.
• Standing whole-spine films, including stitched long films and EOS-type acquisitions, for curve and sagittal measurements.
• Lateral chest radiographs for the vertebral fracture section.
• Flexion and extension laterals of the lumbar spine for dynamic instability.

Requirements

Requirement	Why
Standing AP whole spine	Cobb angles, curve apex and Lenke curve pattern
Standing lateral whole spine including the pelvis	SVA, pelvic incidence, pelvic tilt and sacral slope need the femoral heads and the S1 endplate
Lateral thoracic or lumbar view	Vertebral height loss is graded from T4 to L4 on lateral projections
Pixel spacing with magnification	SVA and slip distances in millimetres; angles do not depend on it

Stitching artefacts, rotation, transitional vertebrae (which affect level counting) and implants are flagged where they limit a measurement.

Optional context

Age and the clinical question (adolescent idiopathic scoliosis, adult deformity, suspected osteoporotic fracture, back pain) in clinical_context; a prior film in prior_files for curve progression.

The result

A sectioned JSON result with vertebral landmarks, measurements and grades; overlays show the endplate lines and angles.

Section	Content
Cobb angle	Vertebral landmarks, proximal thoracic, main thoracic and thoracolumbar/lumbar Cobb angles, curve apex and Lenke curve type
Vertebral fractures	Per-vertebra height loss and Genant grade 0–3 from T4 to L4
Sagittal alignment	SVA, PI, PT, SS, lumbar lordosis, thoracic kyphosis and PI–LL mismatch
Spondylolisthesis	Slip percentage and Meyerding grade per level, and dynamic instability on flexion–extension films
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: TID 1500 Measurement Report for angles, heights and distances; GSPS overlays with landmarks and lines; Encapsulated PDF.
• Scoliosis: Cobb method as defined by the Scoliosis Research Society, Lenke classification of curve type.
• Adult deformity: SRS–Schwab adult spinal deformity classification from the sagittal parameters.
• Vertebral fractures: Genant semi-quantitative method.
• Spondylolisthesis: Meyerding grading of the anterior slip.