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Performance was evaluated on 65 radiographs not used for training, which were measured independently by 6 readers (3 radiologists, 3 surgeons), and the median per measurement was set as the reference standard. Intraclass correlation coefficient (ICC), mean absolute error (MAE), and standard deviation (SD) were used for statistical analysis; while, ANOVA was used to search for significant differences between the AI and human readers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Automatic measurements (AI) showed excellent correlation with the reference standard, with all ICCs within the range of the readers (TK: 0.92 [AI]\u00a0vs. 0.85\u20130.96 [readers]; LL: 0.95 vs. 0.87\u20130.98; SS: 0.93 vs. 0.89\u20130.98; SVA: 1.00 vs. 0.99\u20131.00; all p\u2009&lt;\u20090.001). Analysis of the MAE (\u00b1\u2009SD) revealed comparable results to the six readers (TK: 3.71\u00b0 (\u00b1\u20094.24) [AI] v.s 1.86\u20135.88\u00b0 (\u00b1\u20093.48\u20136.17)\u00a0[readers]; LL: 4.53\u00b0\u2009\u00b1\u20094.68 vs. 2.21\u20135.34\u00b0 (\u00b1\u20092.60\u20137.38); SS: 4.56\u00b0 (\u00b1\u20096.10) vs. 2.20\u20134.76\u00b0 (\u00b1\u20093.15\u20137.37); SVA: 2.44\u00a0mm (\u00b1\u20093.93) vs. 1.22\u20132.79\u00a0mm (\u00b1\u20092.42\u20137.11)); while, ANOVA confirmed no significant difference between the errors of the AI and any human reader (all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Human reading time was on average 139\u00a0s per case (range: 86\u2013231\u00a0s).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Our AI algorithm provides spinopelvic measurements accurate within the variability of experienced readers, but with the potential to save time and increase reproducibility.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11547-025-01957-5","type":"journal-article","created":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T10:58:28Z","timestamp":1737889108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Automated spinopelvic measurements on radiographs with artificial intelligence: a multi-reader study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6248-5128","authenticated-orcid":false,"given":"Boj Friedrich","family":"Hoppe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Rueckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Rudolph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Fink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Weidert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolf","family":"Hohlbein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Cavalcanti-Ku\u00dfmaul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Trappmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Munawwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Ricke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian Oliver","family":"Sabel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"1957_CR1","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1007\/s00586-019-06083-1","volume":"28","author":"JC Le Huec","year":"2019","unstructured":"Le Huec JC, Thompson W, Mohsinaly Y et al (2019) Sagittal balance of the spine. 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J.Rue. and B.O.S. received financial compensation for speaker\u2019s activities by Siemens Healthineers (lectures at conferences not related to this research project).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the institutional review board of the Ludwig Maximilian University of Munich (approval number 18\u2013399). Informed consent was waived due to the retrospective and non-interventional nature of the study. All procedures performed in the study involving human participants were conducted in accordance with the Declaration of Helsinki (as revised in 2013). Animals were not involved.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}