Is Radiation-Free Ultrasound Accurate for Quantitative Assessment of Spinal Deformity in Idiopathic Scoliosis (IS): A Detailed Analysis With EOS Radiography on 952 Patients

Yi shun Wong, Kelly Ka lee Lai, Yong ping Zheng, Lyn Lee ning Wong, Bobby Kin wah Ng, Alec Lik hang Hung, Benjamin Hon kei Yip, Winnie Chiu wing Chu, Alex Wing hung Ng, Yong Qiu, Jack Chun yiu Cheng, Tsz ping Lam

Research output: Journal article publicationJournal articleAcademic researchpeer-review

12 Citations (Scopus)


Radiation exposure with repeated radiography required at follow-up poses serious health concerns for scoliosis patients. Although spinous process angle (SPA) measurement of spinal curvatures with ultrasound has been reported with promising results, an evidence-based account on its accuracy for translational application remains undefined. This prospective study involved 952 idiopathic scoliosis patients (75.7% female, mean age 16.7 ± 3.0 y, Cobb 28.7 ± 11.6°). Among 1432 curves (88.1%) detected by ultrasound, there was good correlation between radiologic Cobb angles measured manually on EOS (E_Cobb) whole-spine radiographs and automatic ultrasound SPA measurement for upper spinal curves (USCs) (r = 0.873, apices T7–T12/L1 intervertebral disc) and lower spinal curves (LSCs) (r = 0.740, apices L1 or below) (p < 0.001). Taller stature was associated with stronger correlation. For E_Cobb <30°, 66.6% USCs and 62.4% LSCs had absolute differences between E_Cobb and predicted Cobb angle calculated from SPA ≤5°. Ultrasound could be a viable option in lieu of radiography for measuring coronal curves with apices at T7 or lower and Cobb angle <30°.

Original languageEnglish
Pages (from-to)2866-2877
Number of pages12
JournalUltrasound in Medicine and Biology
Issue number11
Publication statusPublished - Nov 2019


  • Cobb angle
  • EOS radiography
  • Idiopathic scoliosis
  • Spinous process angle
  • Ultrasound

ASJC Scopus subject areas

  • Biophysics
  • Radiological and Ultrasound Technology
  • Acoustics and Ultrasonics

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