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Diagnosis, surgical planning, and assessment of outcomes are determined primarily by the Cobb angle on anteroposterior spinal radiographs. Screening for scoliosis enables early interventions and improved outcomes. However, screenings are often conducted through school entities where a trained radiologist may not be available to accurately interpret the imaging results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this study, we developed an artificial intelligence tool utilizing a keypoint region-based convolutional neural network (KR-CNN) for automated thoracic Cobb angle (TCA) measurement. The KR-CNN was trained on 609 whole-spine radiographs of AIS patients and validated using our institutional AIS registry, which included 83 patients who underwent posterior spinal fusion with both preoperative and postoperative anteroposterior X-ray images.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The KR-CNN model demonstrated superior performance metrics, including a mean absolute error (MAE) of 2.22, mean squared error (MSE) of 9.1, symmetric mean absolute percentage error (SMAPE) of 4.29, and intraclass correlation coefficient (ICC) of 0.98, outperforming existing methods.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This method will enable fast and accurate screening for AIS and assessment of postoperative outcomes and provides a development framework for further automation and validation of spinopelvic measurements.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06645-x","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T22:42:33Z","timestamp":1755902553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Development and validation of a keypoint region-based convolutional neural network to automate thoracic Cobb angle measurements using whole-spine standing radiographs"],"prefix":"10.1007","volume":"167","author":[{"given":"Mert Marcel","family":"Dagli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Sussman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaskeerat","family":"Gujral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhargavi R.","family":"Budihal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang W.","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali K.","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Cahill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Anari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Winkelstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William C.","family":"Welch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"key":"6645_CR1","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1007\/s00586-020-06577-3","volume":"30","author":"P Bernstein","year":"2021","unstructured":"Bernstein P, Metzler J, Weinzierl M, Seifert C, Kisel W, Wacker M (2021) Radiographic scoliosis angle estimation: spline-based measurement reveals superior reliability compared to traditional COBB method. 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This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients (or their parent or legal guardian in the case of children under 16) provided written informed consent for inclusion in this study. No organs\/tissues were utilized in this study. Only radiographic imaging was utilized in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images in Fig.\u00a0.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"In the past 36 months, AKO has received consulting fees from Medacta and Johnson and Johnson (with no relation to this work) and has served as an E2M ad-hoc reviewer for the Journal of Neurosurgery Publishing Group (JNS PG). Additionally, within the same period, JWY has received a grant from Johnson and Johnson; consulting fees from Medyssey, TrackX, Richard Wolf, and Johnson and Johnson; holds patents planned, issued, or pending with Kinesiometrics and MedCyclops; and has served in a leadership role on the Scientific Program Committee of the AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (with no relation to this work). All other authors report no conflict of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"227"}}