{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:15:00Z","timestamp":1784232900367,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DePuy Synthes Spine"},{"name":"Medtronic"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student\u2019s t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3\u20131.3\u00b0. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test\u2013retest differences (p &gt; 0.05) were observed between researchers (0.948 \u00b1 0.04) and surgeons (0.925 \u00b1 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.<\/jats:p>","DOI":"10.3390\/jcm13072114","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T08:27:52Z","timestamp":1712305672000},"page":"2114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7394-9637","authenticated-orcid":false,"given":"Javier","family":"Pizones","sequence":"first","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Moreno-Manzanaro","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2653-9189","authenticated-orcid":false,"given":"Anika","family":"Pupak","sequence":"additional","affiliation":[{"name":"Spine Research Unit, Vall d\u2019Hebron Institute of Research, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1273-7256","authenticated-orcid":false,"given":"Susana","family":"N\u00fa\u00f1ez-Pereira","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Hospital Universitario Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9123-1466","authenticated-orcid":false,"given":"Daniel","family":"Larrieu","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-5891","authenticated-orcid":false,"given":"Louis","family":"Boissiere","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Richner-Wunderlin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-0476","authenticated-orcid":false,"given":"Markus","family":"Loibl","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tais","family":"Zulemyan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1942-2444","authenticated-orcid":false,"given":"Altug","family":"Y\u00fccekul","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Zgheib","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann Philippe","family":"Charles","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6731-1063","authenticated-orcid":false,"given":"Dong-Gune","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Kleinstueck","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-0508","authenticated-orcid":false,"given":"Ibrahim","family":"Obeid","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Alanay","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"S\u00e1nchez P\u00e9rez-Grueso","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0644-7757","authenticated-orcid":false,"given":"Ferran","family":"Pellis\u00e9","sequence":"additional","affiliation":[{"name":"Spine Surgery Unit, Hospital Universitario Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the 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