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Conference of The International Research Society for Scoliotic Deformity

MEETINGS on spinal deformity in the series of which this Conference, held in Stockholm from 15th to 19th June, 1996, is part, have continued, albeit without formal organization, since 1980. It is apparent that medical imaging is one arena in which very distinct development has occurred over roughly the same period. Around 1980, the photograph and radiograph were the commonly available imaging systems. But imaging systems now being used in spinal deformity studies include a number of newer technologies, such as magnetic resonance imaging (MRI) and computed tomography (CT) while, in addition, the use of ultra-sound imaging is now expanding. Meanwhile, the older technologies, radiography and photography (for measurement by photogrammetry, structured lighting and moire ́ fringing) have now become available with digital output so that they have also undergone something of a significant revolution. Indeed, only since the digitization of camera output by various technologies has the first real introduction occurred of their use for back surface measurement. Digital radiographs are now also finding wider usage. So while it may seem that other imaging methods have become available, the digitization of the photograph and radiograph may well have created a revolution in their use also. More importantly perhaps, digital image processing, which has also emerged significantly in the period since around 1980, is at least as crucial as the availability of the digital imagery to which it is applied. Algorithms and software packages for carrying out image manipulation are widely available and are capable, not simply of enhancing imagery, improving contrasts and filtering or sharpening images, but also of finding points, edges, targets and pre-defined features, of moving regions of interest and to decode, magnify, classify, correlate and so on. The sophistication of fast motion analysis systems attest to the power and value of digital image processing in medical applications. For spinal studies, the same digital imaging and processing has permitted the creation of a number of back topography measurement systems built around digitally recording cameras, even though the various systems use different principles for slightly differing purposes. Commercially, systems with names such as Isis, Auscan, Formetric or Quantec, have become available, while yet other systems are being unveiled or are continually being reported as under development at meetings on spinal deformity or related topics. While the existing products represent positive news, there must be, on the negative side, a recognition that the use of two dimensional images from both cameras and X-ray devices to obtain three dimensional data seems to have generated considerable debate about the preferred methodology of their use and about the medical utilization of information which can be derived from the imagery. Optical systems for external measurement have developed with different target specifications and with no common guidance and hence there has been duplication and waste. The commercial systems which are currently available do not represent the full range of systems which have seen development effort over the years. They may well be those which have survived, possibly from well guided development projects, and because they have managed to output the parameters required by the medical user. Digital radiographs are also making their presence felt although commercial software and hardware does not seem to be widespread. Perhaps some duplication