{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:45:12Z","timestamp":1792003512833,"version":"4.4.0"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"governmental grants-aid-for-scientists","award":["(C) 23K08695"],"award-info":[{"award-number":["(C) 23K08695"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective Cohort Study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Accurate prediction of curve progression in idiopathic scoliosis at the initial visit would facilitate clinical decision-making. In our previous study, progression was predicted using deep learning based on frontal whole-spine radiographs. This study aimed to improve prediction accuracy using a multimodal ensemble model integrating frontal and lateral radiographs with clinical information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study included 527 patients with idiopathic scoliosis. Based on the change in Cobb angle over two years, patients were classified into progression (\u226510\u00b0), non-progression (\u22645\u00b0), and borderline (6\u20139\u00b0) groups. A total of 471 patients (274 progression and 197 non-progression) were analyzed. Input data included initial whole-spine frontal and lateral radiographs and clinical variables (age, sex, Risser sign, and baseline Cobb angle). Deep learning models (Vision Transformer, Swin Transformer, and ConvNeXtV2) and machine learning models (logistic regression, support vector machine [SVM], and random forest) were applied, generating nine models. Predicted probabilities were integrated using weighted averaging. Performance was evaluated using repeated stratified 10-fold cross-validation with the area under the receiver operating characteristic curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age was 12.7 \u00b1 1.8 years, and 433 patients (91.9%) were female. Mean initial Cobb angle was 27.8 \u00b1 10.1\u00b0. The AUCs based on averaged predicted probabilities within each modality were 0.791 for frontal radiographs, 0.767 for lateral radiographs, and 0.721 for clinical features. The weighted ensemble achieved highest performance (AUC 0.819, 95% CI: 0.816\u20130.821), significantly outperforming other ensemble methods (P &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A multimodal ensemble model integrating radiographs and clinical data improved prediction of idiopathic scoliosis progression compared with single-modality models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261474876","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:29:54Z","timestamp":1785522594000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and Validation of a Multi-Modal Ensemble Model for Predicting Progression in Idiopathic Scoliosis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0586-6818","authenticated-orcid":false,"given":"Hideyuki","family":"Arima","sequence":"first","affiliation":[{"name":"Hamamatsu University School of Medicine"},{"name":"Osaka Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Niigata University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4701-8211","authenticated-orcid":false,"given":"Yu","family":"Yamato","sequence":"additional","affiliation":[{"name":"Hamamatsu University School of Medicine"},{"name":"Osaka Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Kameda Daiichi Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruki","family":"Ueda","sequence":"additional","affiliation":[{"name":"Dokkyo Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naobumi","family":"Hosogane","sequence":"additional","affiliation":[{"name":"Kyorin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Kyorin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-6607","authenticated-orcid":false,"given":"Hiroki","family":"Oba","sequence":"additional","affiliation":[{"name":"Shinshu University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Niigata University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3865-0684","authenticated-orcid":false,"given":"Manami","family":"Umezu","sequence":"additional","affiliation":[{"name":"Niigata University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohan","family":"Kondo","sequence":"additional","affiliation":[{"name":"Niigata University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoji","family":"Seki","sequence":"additional","affiliation":[{"name":"University of Toyama"},{"name":"Department of Orthopaedic Surgery, Toyama Rosai Hospital, Uozu, Toyama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.30"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198163050-00003"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60658-3"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466070-00013"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00004"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199506000-00001"},{"key":"e_1_3_8_8_2","first-page":"111","article-title":"The iliac apophysis; an invaluable sign in the management of scoliosis","volume":"11","author":"Risser JC","year":"1958","unstructured":"Risser JC. 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