Vertebra Segmentation and Cobb Angle Calculation Platform for Scoliosis Diagnosis Using Deep Learning: SpineCheck

This study presents SpineCheck, a fully integrated deep-learning-based clinical decision support platform for automatic vertebra segmentation and Cobb angle (CA) measurement from scoliosis X-ray images. The system unifies end-to-end preprocessing, U-Net-based segmentation, geometry-driven angle computation, and a web-based clinical interface within a single deployable architecture. For secure clinical use, SpineCheck adopts a stateless “process-and-delete” design, ensuring that no radiographic data or Protected Health Information (PHI) are permanently stored. Five U-Net family models (U-Net, optimized U-Net-2, Attention U-Net, nnU-Net, and UNet3++) are systematically evaluated under identical conditions using Dice similarity, inference speed, GPU memory usage, and deployment stability, enabling deployment-oriented model selection. A robust CA estimation pipeline is developed by combining minimum-area rectangle analysis with Theil–Sen regression and spline-based anatomical modeling to suppress outliers and improve numerical stability. The system is validated on a large-scale dataset of 20,000 scoliosis X-ray images, demonstrating strong agreement with expert measurements based on Mean Absolute Error, Pearson correlation, and Intraclass Correlation Coefficient metrics. These findings confirm the reliability and clinical robustness of SpineCheck. By integrating large-scale validation, robust geometric modeling, secure stateless processing, and real-time deployment capabilities, SpineCheck provides a scalable and clinically reliable framework for automated scoliosis assessment.