Scoliosis is a complex spinal deformity characterized by abnormal lateral curvature, which can impact patient health and quality of life. Accurate measurement of this curvature is critical in diagnosing scoliosis and planning appropriate interventions. The Cobb angle, a widely accepted metric for quantifying the severity of scoliosis, is traditionally measured manually using a protractor on radiographic images. However, digital advancements in radiology have introduced software tools that can automate Cobb angle measurements, potentially reducing human error and improving measurement consistency. This study aims to evaluate the reliability, accuracy, and clinical applicability of digital versus manual methods for measuring Cobb angles in scoliosis patients.

We conducted a comparative study with a sample of 100 scoliosis patients (aged 10-30 years) who underwent standard anteroposterior (AP) spinal radiography. Cobb angles were measured using both manual (protractor-based) and digital (software-assisted) techniques by two independent radiologists. Measurements were repeated after two weeks to assess intra- and inter-observer variability. Statistical analysis, including intra-class correlation coefficients (ICCs) and paired t-tests, was applied to compare the two methods.

Results indicated that digital measurements had significantly higher intra- and inter-observer reliability (98% and 96%, respectively) compared to manual measurements (92% and 88%, respectively). Although the mean Cobb angle values were similar between methods (28.4° for digital and 27.9° for manual), digital measurements exhibited less variability, indicating more consistent results. Digital tools were also observed to be more efficient, reducing measurement time and effort, making them more practical in high-throughput clinical settings.