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Abstract
Introduction
The purpose of the study was to check the intrarater reliability of the Raimondi system
measuring vertebral rotation directly on a computer screen.
Background
The measurement of vertebral axial rotation according to Perdriolle and to Raimondi
is reliable on standard films, where apical vertebrae show a proper size for the scale
of both systems. Current digital radiographs are delivered on a CD format (screen)
or on a film format, usually with a non proper size for the two above mentioned methods.
No system has been described for a rapid assessment of vertebral rotation directly
from the screen. Raimondi system, with no needs for reference marks, could be considered
a proper tool to be use for that purpose. The size of the apical vertebra can be increased
as much as necessary when using CD format as well as digital photography. However
this could be considered, together with other factors, a source of error.
Methods
Vertebral rotation was measured according to Raimondi twice by the same observer on
45 apical vertebrae (thoracic, thoracolumbar and lumbar) from a set of 27 radiographs
(12 CDs and 15 digital photos) directly on the computer screen.
Results
Intrarater reliability was r= .968 (r= .991 on standard films). The mean intrarater
error was 2.4 degrees (0.4 degrees on standard films).
Discussion
No rapid and practical way to measure vertebral rotation has been shown when assessing
scoliosis directly from CDs. On the other hand, when patients provide films from digital
radiographs, such a films use to be too small in a way that the transversal diameter
of the apical vertebra is less than 20mm. Thus, nor Perdriolle method neither Raimondi
are useful tools to measure vertebral rotation on those films. An alternative method
is to use a digital photo from the film, which can be managed to change the size of
the apical vertebra by using any of the common photo viewers available in PCs. Raimondi
method needs no reference marks and showed good intrarater reliability as well as
a low mean measurement error when used on standard radiographs. For this reason it
was considered the best candidate method to use for direct measurements of the vertebral
rotation on the computer screen from both CDs and digital photos. Although intrarater
reliability is still good, the results of this study does not reproduce those from
previous studies when measuring on classical radiographs, suggesting that errors could
come from different sources: the screen itself or variability produced by the change
of the vertebral size when looking for a proper proportion to use this particular
method.
Conclusions
Raimondi method is useful and practical tool for the measurement of vertebral rotation
directly on a computer screen in a busy clinical setting; however, due to the relatively
high mean intrarater error found in this present study, it should be used cautiously,
even by an experience clinician, when making decisions.