Systems and Methods for Detection of Musculoskeletal Anomalies

Abstract

Systems and methods for the detection of musculoskeletal anomalies are disclosed. Various embodiments are directed to methods to detect and treat anomalies, including fracture (e.g. clavicle), deformity (e.g. scoliosis), and other anomalies. Various embodiments utilize structured white light scanners, while additional embodiments utilize LiDAR to generate 3-dimensional (3D) topographic scans. Various embodiments obtain these scans via a mobile device, such as a mobile phone or tablet. Further embodiments utilize machine learning models to analyze the 3D scans to identify an anomaly and/or a treatment for such anomaly and/or monitor change of that condition over time.

Claims

1. A three dimensional diagnostic system comprising: a three dimensional scanning device capable of obtaining a three dimensional scan of a human body without emitting ionizing or other damaging radiation; and a computing device in communication with the three dimensional scanning device and capable of generating a mesh from a three dimensional scan and analyzing said mesh to identify a musculoskeletal anomaly.

2. The system of claim 1, wherein the three dimensional scanning device is a white light scanning camera or a LiDAR-enabled camera.

3. The system of claim 1, wherein the computing device is a mobile device.

4. The system of claim 3, wherein the mobile device is selected from a mobile phone, a tablet, a laptop computer, or a notebook computer.

5. The system of claim 1, wherein the computing device is capable of transmitting data over a network.

6. The system of claim 1, further comprising a remote server connected to the computing device via a network. 7 A method for detecting and monitoring scoliosis comprising: obtaining a 3D topographic scan of a subject's body using a 3D topographic imaging device; analyzing the 3D topographic scan by: identifying a plurality of key feature points on the regions of the 3D topographic scan reflecting the back of the subject; measuring a distance or angle between at least a first key feature point and a second key feature point in the plurality of key feature points; identifying scoliosis based on the distances, angles, and volumetric relationships quantified in upright and bending poses; classifying the scoliosis as in need of orthopaedic referral or not in need of orthopaedic referral; and classifying the scoliosis as operative, eligible for casting and/or bracing or not in need of intervention; and treating the subject based on the classification of the scoliosis.

8. The method of claim 7, wherein the plurality of key features are selected from the group consisting of: the midsternal notch, the superior/anterior aspect of the acromioclavicular joint, the posterior/lateral border of the acromion, the C7 spinous process, the inferior angle of the scapula, the nipples, the olecranon process, the anterior superior iliac spine, greater trochanter, patella, ankle malleoli, and digits.

9. The method of claim 7, wherein the treating step includes a surgical operation, other non-surgical intervention, or physical therapy.

10. The method of claim 9, further comprising: obtaining a second 3D topographic scan of the subject's body post-treatment; identifying a second plurality of key feature points in the second 3D topographic scan using a fracture detector; measuring a distance, angle, or volumetric change between at least a first key feature point and a second key feature point in the second plurality of key feature points using the fracture detector; calculating the difference in the measured distance, angles or volumetric change; and tracking the subject's recovery based on the calculated differences in distances, angles or volumetric measurements of interest.

11. The method of claim 10, wherein the plurality of key features are selected from the group consisting of: the midsternal notch, the superior/anterior aspect of the acromioclavicular joint, the posterior/lateral border of the acromion, the C7 spinous process, the inferior angle of the scapula, the nipples, the olecranon process, the anterior superior iliac spine, greater trochanter, patella, ankle malleoli, and digits.

12. The method of claim 7, wherein the 3D topographic scan is accomplished using a structured light scanner or LiDAR-enabled camera.

13. The method of claim 12, wherein the 3D topographic scan is accomplished using a mobile device.

14. The method of claim 13, wherein the mobile device is selected from a mobile phone or tablet.

15. A method for detecting and treating clavicle fractures comprising: obtaining a 3D topographic scan of a subject's body using a 3D topographic imaging device; identifying a plurality of key feature points on the regions of the 3D topographic scan reflecting the shoulders and back of the subject; measuring a distance between at least a first key feature point and a second key feature point in the plurality of key feature points; identifying a clavicle fracture based on the distance; classifying the clavicle fracture as operative or non-operative; and treating the subject based on the classification of the clavicle fracture.

16. The method of claim 15, wherein the plurality of key features are selected from the group consisting of: the midsternal notch, the acromial process, the superior/anterior aspect of the acromioclavicular joint, the posterior/lateral border of the acromion, the C7 spinous process, the inferior angle of the scapula, the nipples, the olecranon process, the anterior superior iliac spine, greater trochanter, patella, ankle malleoli, and digits.

17. The method of claim 15, wherein the treating step includes a surgical operation.

18. The method of claim 17, further comprising: obtaining a second 3D topographic scan of the subject's body post-operatively; identifying a second plurality of key feature points in the second 3D topographic scan using a fracture detector; measuring a distance between at least a first key feature point and a second key feature point in the second plurality of key feature points using the fracture detector; calculating the difference in the measured distances; calculating volumetric relationships within 3D scans; and tracking the subject's recovery based on the calculated differences.

19. The method of claim 18, wherein the plurality of key features are selected from the group consisting of: the midsternal notch, the superior/anterior aspect of the acromioclavicular joint, the posterior/lateral border of the acromion, the C7 spinous process, the inferior angle of the scapula, the nipples, the olecranon process, the anterior superior iliac spine, greater trochanter, patella, ankle malleoli, and digits.

20. The method of claim 15, wherein the 3D topographic scan is accomplished using a structured light scanner or LiDAR-enabled camera.

21. The method of claim 20, wherein the 3D topographic scan is accomplished using a mobile device.

22. The method of claim 21, wherein the mobile device is selected from a mobile phone or tablet.

23. A method for detecting musculoskeletal anomalies comprising: obtaining a 3D topographic scan of a subject's body using a 3D topographic imaging device; performing range of motion, center of gravity, asymmetry, or posture analysis on the 3D topographic scan by bisecting the scan with one or more lines and measuring a key feature along the one or more lines; and identifying a musculoskeletal anomaly based on the distance.

24. The method of claim 23, wherein the 3D topographic scan is accomplished using a structured light scanner or LiDAR-enabled camera.

25. The method of claim 23, wherein the 3D topographic scan is accomplished using a mobile device.

26. The method of claim 25, wherein the mobile device is selected from a mobile phone or tablet.

27. The method of claim 23, wherein the musculoskeletal anomaly is selected from scoliosis, back pain, neck pain, joint pain, sarcopenia, arthritis, osteoporosis, bone and soft tissue injury.

28. The method of claim 23, wherein obtaining the 3D topographic scan is accomplished by converting one or more two-dimensional images into a 3D representation of the subject's body.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0034] These and other features and advantages of the present invention will be better understood by reference to the following detailed description when considered in conjunction with the accompanying drawings where:

[0035] FIG. 1A illustrates a method for detecting and treating musculoskeletal anomalies in accordance with various embodiments of the invention.

[0036] FIGS. 1B-1H illustrates exemplary measurements for analyzing specific features in accordance with various embodiments of the invention.

[0037] FIG. 2 illustrates an exemplary system for detecting and treating musculoskeletal anomalies in accordance with various embodiments of the invention.

[0038] FIG. 3 illustrates exemplary results of scores for injured and non-injured clavicles in accordance with various embodiments of the invention.

[0039] FIG. 4 illustrates exemplary results of a shoulder deformity identified in surgical and non-surgical patients over time in accordance with various embodiments of the invention.

[0040] FIG. 5 illustrates hand measurements for shoulder deformities for surgical and non-surgical patients in accordance with various embodiments of the invention.

[0041] FIG. 6A-6I illustrate exemplary comparisons of 3D scans, cobb angle, and a scoliometer in accordance with various embodiments of the invention.

[0042] FIGS. 7A-7L illustrate exemplary correlations between Patient Reported Outcome Measurements (PROMs) in radiography, 3D scans, and scolimetry in accordance with various embodiments of the invention.

DETAILED DESCRIPTION

[0043] Turning now to the diagrams and figures, embodiments of the invention are generally directed to systems and methods to detect musculoskeletal anomalies. Systems and methods described herein can use visible spectrum light to obtain a three dimensional (3D) topographic scan of a patient and use the scan to detect musculoskeletal conditions such as, but not limited to, fractures, and/or any other musculoskeletal injury or anomaly as appropriate to the requirements of specific applications of embodiments of the invention. Specific addressable conditions include but are not limited to, scoliosis, back pain, neck pain, joint pain, sarcopenia, arthritis, osteoporosis, bone and soft tissue injury, flexibility, mobility, muscle strength, imbalances, posture analysis, body, bone, fat, muscle mass, metabolic rate, circumference and volume of various body parts. In many embodiments, the 3D scan describes the surface of the patient's body, and contains no internal information (e.g., a mesh).

[0044] By measuring particular key feature points, an accurate estimation can be made of whether or not an injury, deformity, or degeneration over time has occurred. In numerous embodiments, as supported by empirical studies, measurement of the same key feature points as performed by a human render less precise results. Many embodiments are deployed as portable devices, including as attached to or as part of a mobile phone or tablet to allow systems to be deployed outside of clinics, hospitals, or other medical facilities.

[0045] Turning to FIG. 1A, an exemplary embodiment describing a method 100 to treat an individual for musculoskeletal anomaly is illustrated. At 102, many embodiments obtain a 3D scan of an individual in a predefined pose dependent on the suspected musculoskeletal deformity. In many embodiments, a three-dimensional scanner, such as, but not limited to, a structured light scanner, LiDAR-enabled camera, including LiDAR-enabled cameras within newer mobile device and tablet models, or other light-based imaging system, is used to capture the 3-dimensional shape of, and/or quantify asymmetry of the human body. In numerous embodiments, data can but does not require encryption and automatically handled in a HIPAA compliant manner unless specified for medical legal compliance. In various embodiments, the 3D scan creates a mesh (e.g., solid file) of the body based on the 3D scan. In some embodiments, holes in the mesh are patched. In many embodiments, multiple 3D scans are obtained of an individual. For example, anterior and posterior views.

[0046] Additionally, some embodiments obtain 3D scans of an individual in different positions, such as standing, bending, sitting, and/or any other position relevant for a particular purpose. Some embodiments obtain 3D scans taken of an individual in a bent position (e.g., Adam's Forward Bend position) to maximally expose spinal curvature. In certain embodiments, 3D scans are obtained with one or both arms, one or both legs, and/or the head/neck in a specific position that allows for measurements of particular features dependent upon specific motions or specific positions of one or more appendages. Further embodiments obtain 3D video scans of an individual, in that the 3D scan is obtained as a continuous series of images over time. Certain embodiments construct 3D images of an individual based on one or more 2D images or a video that can be converted into a single 3D representation, via stitching, reconstruction, or other method of constructing a 3D representation from one or more 2D images.

[0047] At 104 of various embodiments, 3D representations are analyzed to identify a musculoskeletal anomaly. In numerous embodiments, systems and methods described herein can identify shoulder and spinal deformities such as clavicle fractures, scoliosis, and other deformities, diseases, or anomalies. In some embodiments, analysis is accomplished by communicating scans across a network and/or via the cloud to a central server for processing, while some embodiments analyze the 3D scans locally.

[0048] In many embodiments, the 3D representation is analyzed by demarcating various lines or representations and identifying ratios, angles, torsions, rotations, or other differences between these lines.

[0049] In various embodiments, a three-dimensional plane is demarcated from the center of the midsternal notch/umbilicus and the C7 spinous process/intergluteal cleft to divide the body into halves. Palpable anatomic landmarks can be utilized as key feature points such as, but not limited to: the midsternal notch, the superior/anterior aspect of the acromioclavicular joint, the posterior/lateral border of the acromion, the C7 spinous process, the acromial process, the inferior angle of the scapula, the nipples, the olecranon process, the anterior superior iliac spine, greater trochanter, patella, ankle malleoli, and digits. Many embodiments analyze distances between these landmarks, angles formed between these landmarks, and volumetric differences between areas of interest as well as between these landmarks and the ground to demonstrate the magnitude of topographical asymmetry.

[0050] In many embodiments, volumetric asymmetry is calculated through targeted volumetric comparison of the two halves of the body utilizing aforementioned anatomic landmarks. Asymmetric dynamic motion of the limb can also be calculated by comparing the change in relationships between the aforementioned landmarks through a range of motion. Output can be represented as absolute and relative asymmetry compared to the respective contralateral body part of interest or with respect to prior measurements demonstrating change over time.

[0051] FIG. 1B illustrates an exemplary method of analyzing 3D representations in accordance with some embodiments. Some embodiments draw three axial lines on the body, with a first axial line 152 located at the hip or pelvis, a second axial line 154 located at the neck, and a third axial line 156 located at an area of the trunk with largest deformity. In such embodiments, each line passes from the left midsagittal line to right midsagittal line. In some embodiments, the 3D lines are drawn parallel to the ground which is intrinsically to the 3D representation. In many embodiments, the area of largest deformity along the inferior/superior axis is determined by taking axial cuts throughout the torso and measuring the difference in area between left and right sagittal hemispheres within the two dimensional (2D) contour created by the axial cut. The location where this difference is at a maximum is annotated, and the third axial line 156 is drawn from left mid-sagittal line to right mid-sagittal line is drawn to cross through this point.

[0052] Turning to FIG. 1C, further embodiments determine coronal balance 158 and trunk shift 160 of the individual. In many embodiments, coronal balance is defined as a shift in a midpoint of the first axial line 152 and a midpoint of the second axial line 154, while the trunk shift is defined as a shift in a midpoint of the first axial line 152 and a midpoint of the third axial line 156.

[0053] To measure an angle of trunk rotation, such as for scoliosis, various embodiments utilize scans from a bent position (e.g., Adam's Forward Bend position). In such embodiments, slices are obtained from the 3D representations perpendicular to the mid-sagittal line along the torso and the points of largest deformity are identified in the lower back (lumbar spine) and upper back (thoracic spine). As illustrated in FIG. 1D, a horizon line 162 is determined by connecting a left midsagittal line with a right midsagittal line. The angle of trunk rotation 164 is the angle made by the posterior portion of the slice compared to the horizon line 162. FIG. 1E illustrates examples of displacement and circumferential distance measured from relative to a horizon line 162 in accordance with various embodiments. In many embodiments, displacement is calculated from the left midsagittal line to the projection 166 of the axis of rotation onto the horizon line and subsequently from the right midsagittal line to the projection of the axis of rotation onto the horizon line. Additionally, certain embodiments calculate circumferential distance 168 as a distance from the left midsagittal line to axis of rotation and right midsagittal line to axis of rotation.

[0054] Furth embodiments expand on these abilities by mapping spinal curvature from 3D representations or scans in any position, including at least one of standing, sitting, and bending. FIGS. 1F-1G illustrate on method in accordance with some embodiments to map spinal curvature. In particular, a plurality of axial slices 168 are made parallel to the ground. Within each slice 168, rotation is identified based on an angle created by the posterior portion of the torso and the horizon line 162. Further, displacement of the axis of rotation 170 in each slice 168 is measured from the mid-sagittal line is identified based on bilateral measurements 172, 172 between the axis of rotation 170 and a centroid 174. With measurements obtained from each slice, 3D reconstructions can be reassembled for the spinal curvature. An exemplary displacement is illustrated in FIG. 1H that can be used to approximate spinal curvature. With such reconstructions, these embodiments can quantify left versus right asymmetry, deformity, and/or deformation, either statically or over time. Such methods facilitate detection and monitoring of other orthopedic conditions (osteoporosis, frailty, arthritis, back/neck pain, injury, and/or other malformations).

[0055] In various embodiments, systems and methods described herein can quantify static and dynamic asymmetry of the body to assist as a decision aid for medical decision making or personal wellness monitoring. For example, shoulder deformity after isolated clavicle fracture can be detected utilizing this methodology. In some embodiments, when diagnosing clavicle fracture, a structured-light scanner captures the three-dimensional shape of the shoulder girdle bilaterally. Non-traumatic musculoskeletal deformity, such as that in scoliosis, may also be captured utilizing similar methodology. In some embodiments, scoliotic deformity may be quantified by capturing the three-dimensional shape of the spine in upright and bending poses. Data captured from three-dimensional scans and then uploaded to a photogrammetric musculoskeletal software for analysis of three-dimensional measurements of anatomical relationships based upon specific landmarks.

[0056] In some embodiments, these palpable and visible anatomic landmarks are validated through academic clinical trials. For example, for a clavicle fracture, the specific landmarks include suprasternal notch, superior/anterior aspect of the acromioclavicular joint, posterior/lateral border of the acromion, inferior angle of the scapula, and C7 spinous process. Distance and the angles formed between these chosen landmarks are analyzed with the software to demonstrate the magnitude of topographical asymmetry compared to the injured and uninjured side. The injured and uninjured shoulder girdles are compared, with each patient to serve as their internal reference. The relative difference in the shoulder ptosis defined by these anatomic landmarks, specifically the distance from the midsternal notch to the acromial clavicular joint can identify displaced clavicle fractures that would benefit from operative management without the use of radiation. Further, the difference in distance and angles formed by the aforementioned landmarks is analyzed to monitor the restoration of anatomy or persistence of deformity to monitor the healing of their fracture without the use of radiation. Manual surface measurements of the landmarks are not as predictive due to a lack of sensitivity, thus validating the digital technology and methods. The restoration of anatomy or presence of persistent deformity after clavicle fracture as identified by described methodologies have predictive clinical relevance in terms of pain and return to function defined by objective outcome scores.

[0057] In an exemplary embodiment assessing scoliosis, upright and bending scans are used in conjunction to quantify three-dimensional scoliotic deformity. First, the location of the hip joints is estimated using the center of mass of each leg. The mid-point between the two estimated hip joints is then found to estimate the central sacral vertical line. The circumference of the torso is calculated transversely from cranial to caudal, and orthogonal line is drawn through the center of mass of the circumference on the transverse plane with the largest asymmetry. This line is projected onto a coronal plane and compared to the projection of the central sacral vertical line on the same coronal plane to calculate trunk shift. Next, a circumference is drawn transversely around the neck, and an orthogonal line is drawn through the center of mass of this circumference. The orthogonal line is projected onto the same coronal plane previously used in the trunk shift calculation, and is compared to the projection of the central sacral vertical line to determine coronal balance. Shoulder balance and clavicle angle are calculated using the anterior or posterior acromioclavicular joints, dependent on which is most prominent on a particular patient. In the case that these landmarks are not easily seen, the apex of each shoulder is compared to generate the same calculation. For calculation of angle of trunk rotation, splines are drawn from the estimated location of the hips to the center of the shoulder as determined from anterior to posterior. Lines are drawn from one side to another, and the angle of the back is compared to the coronal line created by the splines along the back. The largest angle in the lumbar spine is the lumbar angle of trunk rotation, and the largest angle in the thoracic spine is the thoracic angle of trunk rotation.

[0058] The aforementioned clinical scenarios, are just examples of utilization of these methods detects and monitor musculoskeletal abnormalities or conditions. Other clinical applications of similar methods include but are not limited to neck and back pain/injury, arthritis, osteoporosis, sarcopenia, soft tissue injury, laxity, and/or muscle atrophy/hypertrophy.

[0059] In many embodiments, the analysis is based on a machine learning model. In many embodiments, the machine learning model is trained from 3D scans of individuals, including individuals with new anomalies as well as individuals with categorized anomalies, such as clavicle fracture, scoliosis, a deformity, and/or any other anomaly. Further embodiments further include treatment prognostics or outlook, such as probable outcome from surgical intervention, physical therapy, sports medicine, pharmacological/pharmaceutical therapy (e.g., pain management), and/or other clinical treatment.

[0060] Returning to FIG. 1A, at 106, many embodiments generate recommendations for treatment specified to the type and severity of identified conditions. For example, in many embodiments, conditions can be classified as operative or non-operative, a particular surgical treatment can be recommended, and/or any other treatment regime can be selected based on identified conditions as appropriate to the requirements of specific applications of embodiments of the invention. In some embodiments, the prognostics are based on severity of any such anomaly, such that severe cases may recommend surgical intervention, while less severe cases may recommend less invasive intervention, such as monitoring, bracing/casting, and/or physical therapy.

[0061] At 106, embodiments may also generate recommendations for further evaluation by a specialist. For example, in scoliosis, a primary care provider or school nurse may obtain a three-dimensional scan and use the information obtained to determine whether referral to or discussion with an orthopaedic specialist is indicated.

[0062] Ongoing monitoring occurs at 108 of many embodiments. During ongoing monitoring, these embodiments follow up with a patient or individual via out-of-office surveys (e.g., patient-reported outcome measures, or PROM) or in-office examination, such as for freedom of movement, range of motion, QuickDASH, or any other applicable metric for a particular musculoskeletal anomaly identified within the individual. In some embodiments, the ongoing monitoring includes additional scans, such as acquired at 102, which can allow for some embodiments to analyze and make additional recommendations for treatment or care based on any changes to an individual's condition.

[0063] It should be noted that in various embodiments, certain features of method 100 may be omitted, repeated, and/or completed in a different order (included in parallel or at substantially the same time). For example, obtaining a 3D scan 102 can include having obtained a 3D scan, such that the 3D scan is performed by a different entity and stored or transmitted to a system for analysis. Additionally, multiple analyzing 3D representation 104 features can be used, such that different parameters or different areas or regions of the scan can be analyzed as necessary for the determining a deformity, break, and/or other anomaly. Similarly, multiple treatment recommendations 106 can be made, should multiple anomalies be discovered. In many embodiments, the analysis 104 and recommendation 106 features can be accomplished simultaneously and/or with a single machine learning model.

[0064] Turning to FIG. 2, an exemplary system for detecting skeletal anomalies is illustrated. In many embodiments, a 3D scan is accomplished using a 3D scanning device 202. In many embodiments, the 3D scanning device 202 is portable, such that it can be moved and/or deployed easily. In many embodiments, the 3D scanning device 202 is capable of obtaining scans of a human body without emitting ionizing or other damaging radiation, such as a white light scanning camera or a LiDAR-enabled camera.

[0065] Many embodiments deploy the 3D scanning device 202 is in communication with a computing device 204. In certain embodiments, the computing device 204 is capable of storing and transmitting data, including transmitting data over a network. In certain embodiments, the 3D scanner (e.g., white light scanner or LiDAR system) is innate to the device, while some embodiments utilize deploy the 3D scanner peripheral device attached to the computing device 204. In certain embodiments, the communication between the 3D scanning device 202 and the computing device 204 is a wired communication, such as via USB, serial, audio, RCA, HDMI, coaxial, and/or other form of wired communication, while some embodiments use wireless communication, such as Bluetooth, wi-fi, RF, or other wireless communication systems.

[0066] In many embodiments a computing device 204 is a mobile or portable device, such as a mobile phone, tablet, laptop/notebook computer, to allow portability and ease of operation outside of a medical facility. Various embodiments analyze an acquired 3D scan for skeletal anomalies (e.g., broken bone, deformity, etc.) locally, while in some embodiments, computing device 204 is connected to a network 206 (e.g., wired or wireless) to allow communication of a 3D scan to other devices, such as a server 208.

[0067] In embodiments connected to a server 208 allow for a higher processing power and/or storage capacity for 3D scans. In such embodiments, a server 208 analyzes such scans to diagnose and/or make recommendations for treatment and/or ongoing care.

Embodiments are Capable of Identifying Anomalies

[0068] Turning to FIG. 3, exemplary results of scores for injured and non-injured shoulders are illustrated. As seen in FIG. 3, many embodiments are capable of identifying or discerning an injury or anomaly based on the scans obtained from an individual.

[0069] Additionally, many embodiments are capable of identifying persistent deformities over time. Turning to FIG. 4, exemplary results of a shoulder deformity identified in surgical and non-surgical patients over time illustrates that many embodiments are capable of identifying a persistent deformity in non-surgical patients, while normal anatomies are restored in the surgical patients. In contrast, FIG. 5 illustrates hand measurements for shoulder deformities for surgical and non-surgical patients. As seen in in FIG. 5, hand measurements are not sensitive enough to show a difference in improvement of the deformity over time.

[0070] Turning to FIGS. 6A-6C, various embodiments of 3D-scanning based detection of musculoskeletal anomalies correlate to radiographic (e.g., X-ray based) detections. In particular, various embodiments show correlations between trunk shift (FIG. 6A), coronal balance (FIG. 6B), and clavicle angle (FIG. 6C). Additionally, FIGS. 6D-6I illustrate how certain embodiments of 3D-scanning based detection (FIGS. 6D-6F) of angle of trunk rotation correlate to radiographic measurements of cobb angle better than traditional means using a scoliometer (FIG. 6G-6I), including overall (FIGS. 6D and 6G), thorax (FIGS. 6E and 6H) and lumbar (FIGS. 6F and 6I). FIGS. 6A-6I illustrate that various embodiments correlate to radiography and supplant radiography as a means to detect musculoskeletal anomalies.

[0071] Additionally, FIGS. 7A-7L illustrate correlations patient-reported outcome measures (PROMs) in terms of the SRS scores. Specifically, FIGS. 7A-7C illustrate correlations with total SRS scores versus various methods of measuring various anomalies, FIGS. 7D-7F illustrate correlations with SRS pain scores, FIGS. 7G-7I illustrate correlations with SRS appearance scores, and FIGS. 7J-7L illustrate correlations with SRS mental scores versus maximum cobb angle (FIGS. 7A, 7D, 7G, and 7J), maximum angle of trunk rotation (FIGS. 7B, 7E, 7H, and 7K), and maximum scoliometer measurement (FIGS. 7C, 7F, 7I, and 7L). FIGS. 7A-7L illustrate that various embodiments are comparable to radiographic and scoliometer measurements.

[0072] Additionally, various embodiments are capable of making treatment suggestions or recommendations. As seen in Tables 1A-1G illustrate information regarding various subjects, including demographic information, SRS Scores, and various scores obtained from radiography, 3D scans, and output including recommendations for intervention. A full description of the headings are illustrated in Table 2.

EXEMPLARY EMBODIMENTS

[0073] Although the following embodiments provide details on certain embodiments of the inventions, it should be understood that these are only exemplary in nature, and are not intended to limit the scope of the invention.

Example 1: Mobile Device Based 3D Scanning Accurately Captures Deformity in Adolescent Idiopathic Scoliosis

[0074] BACKGROUND: Diagnosis and management of adolescent idiopathic scoliosis (AIS) currently relies on in-person clinical and radiographic examination. Characterization of deformity in adolescent idiopathic scoliosis (AIS) is typically described by metrics such as trunk shift, coronal balance, clavicle angle, and angle of trunk rotation. Structural analysis of 3D scans of patients in forward bend position provides an opportunity to further characterize this deformity. White-light 3D scanning (WL3D) can generate high quality 3D representations of surface anatomy using a mobile device. It was hypothesized that WL3D would provide accurate deformity assessments compared to scoliometer and radiographic measurements. Additionally, this study describes a novel measurement method for AIS deformity characterization.

[0075] Methods: Prospective enrollment included patients 10 to 18 years old with AIS, who had a scoliosis radiograph within 30 days of clinic presentation and no history of spinal surgery. 3D scans were taken in the upright and Adams forward bend positions, after which patients completed the SRS-30. Image processing software was used to make 3D measurements of trunk shift, coronal balance, and clavicle angle in upright position and angle of largest trunk rotation (ATR) as detected in the lumbar and thoracic spine in bending position. Modeling software was used to make axial slices of the torso orthogonal to the line of curvature created by the patient's back. The slice passing through the area with the largest angle of trunk rotation was analyzed. A line representing the horizon was drawn axially from left to right mid-sagittal line, and a perpendicular line was drawn from the posterior axis of rotation of the trunk to the horizon line. Bilateral circumferential distance along the posterior edge from mid-sagittal line to the axis of rotation and the area created by each posterior quadrant was measured to quantify asymmetry. 3D trunk shift, coronal balance, clavicle angle were compared to their analogous radiographic measurements, and ATR was correlated to cobb angle from radiographs and angle of trunk rotation as measured by a scoliometer (SM).

[0076] RESULTS: Sixty-three patients were included in the study. Mean coronal Cobb angle was 33.1, range: 10 to 100 degrees. Correlations between the clavicle angle, shoulder height, trunk shift, and coronal balance measurements taken from 3D topographical and radiographic measurements were 0.95, 0.85, and 0.71 respectively. Correlations between cobb angle and 3D ATR were 0.7 overall (FIG. 6D), 0.73 in the thoracic spine (FIG. 6E), and 0.66 in the lumbar spine (FIG. 6F). Correlations between cobb angle and SM were 0.64 overall (FIG. 6G), 0.73 in the thoracic spine (FIG. 6H), and 0.38 in the lumbar spine (FIG. 6I). A univariate model more accurately predicts cobb angle as a function of the 3D ATR (p<0.01) compared to a univariate model that predicts cobb angle as a function of scoliometer measurement (p=0.154).

[0077] Patients with surgical curves (CM>40) had significantly larger axial area asymmetry. Patients with at least bracing range curves (CM>20) had significantly larger axial area asymmetry compared to those with Cobb angle <20. CM and total SRS score had a correlation of 0.5. Difference in quadrant area had a correlation of 0.53 with total SRS. Difference in circumferential distance had a correlation of 0.5 with total SRS.

[0078] CONCLUSION: Obtaining a 3D scan of patients with AIS offers an opportunity to further characterize deformity beyond currently accepted metrics. Portable 3D scanning identifies clinically relevant scoliotic deformity and is more predictive of radiographic cobb angle than scoliometer examination. This new modality can facilitate scoliosis screening and monitoring without in-person clinic visits or radiation exposure.

DOCTRINE OF EQUIVALENTS

[0079] While the above description contains many specific embodiments of the invention, these should not be construed as limitations on the scope of the invention, but rather as an example of one embodiment thereof. Accordingly, the scope of the invention should be determined not by the embodiments illustrated, but by the appended claims and their equivalents.

TABLE-US-00001 TABLE 1A subjectid new age gender srs_available srs_pain_hm srs_appearance_hm srs_activity_hm 1 N 16 M Y 4 4.25 3.5 2 Y 13 F Y 3.6 3.5 3.8 3 N 14 F Y 5 4.5 4.2 4 N 12 M Y 4 2.666666667 3.8 5 N 16 F Y 4.2 3 4.2 7 N 12 F Y 4.6 4.166666667 4.6 8 N 11 M Y 5 3.6 3.8 9 N 14 M Y 4.6 4 4.6 10 N 11 M Y 3.4 3.8 3.2 11 N 13 F Y 5 3.67 3.2 12 N 15 F Y 4.6 4.33 4.6 13 N 13 F Y 5 4.6 4.4 14 N 12 F Y 4.2 4.17 3.4 15 N 16 M N 16 N 12 F Y 4.4 4.6 4.6 17 N 14 F N 18 N 12 M Y 5 3.83 4 19 N 16 F Y 3.4 1.5 4 21 N 18 F Y 3.8 2.33 4.6 22 N 13 M Y 5 3.4 4.2 23 N 11 M N 24 N 13 F Y 4 3 4.2 25 N 17 M Y 3.8 2.5 3.2 26 N 16 F Y 4.4 3.17 4 27 N 13 F Y 3.8 3 4 29 N 13 F Y 4.8 4.33 4.6 30 N 15 F Y 4.4 3.5 3.4 31 N 16 F Y 4.2 3.33 3.6 32 N 11 F Y 5 4.5 4.6 33 N 12 M Y 4.8 3.5 4.4 34 N 11 F Y 4.2 3.5 4 35 N 17 F Y 3.6 3.67 4.6 36 N 13 F Y 3.8 3.67 4.4 37 N 16 F Y 4 2.5 4.4 38 N 14 M Y 5 4 4.4 39 N 13 F Y 2.4 2.33 4.2 40 N 17 M Y 3.6 3.5 4.2 41 N 15 F Y 4.6 4 4.6 42 N 13 F Y 5 4.67 4.6 43 N 16 F Y 3.8 4.33 2.8 44 N 13 F Y 3.8 3.17 4.2 45 N 13 M Y 5 4.83 4 46 N 12 M Y 5 4 3.8 47 N 14 M Y 5 4.67 4.6 48 N 16 F Y 4.4 3.67 4.4 50 N 16 F Y 5 4.67 4.6 51 N 15 M Y 4.8 4.17 4.2 52 N 15 F Y 3.8 3.33 3.8 53 N 16 F Y 4.8 4.33 3.2 55 N 17 M Y 3 3.83 4.4 56 N 14 F Y 3.8 4.33 4.4 57 N 18 F Y 4.2 3.5 3.8 59 Y 12 M Y 5 2.83 4.8 61 Y 16 F Y 5 4.5 4.6 62 Y 13 F Y 5 3.5 4.6 63 Y 13 M Y 5 3.5 4.6 65 Y 12 M Y 4.6 3.67 4.6 66 Y 13 F Y 5 5 4.4 67 Y 15 F Y 5 4.33 4.2 68 Y 16 M Y 4.4 4.17 4.4 69 Y 14 F Y 3.8 3 3.8 71 Y 11 F Y 5 4.67 4.4 72 Y 14 M Y 4.4 4.33 4.6 73 Y 15 M Y 4.6 3.83 4 74 Y 15 M Y 5 3.5 4.4

TABLE-US-00002 TABLE 1B subjectid srs_mental_hm srs_satisfaction_hm srs_tscore_hm srs_hmscore maxATR maxcobb 1 5 4.18 7.125 10 2 3 3 3.41 5 16.641 49 3 4.6 4.5 4.59 11.57 21 4 3.4 4 3.5 4.666666667 8.947 17 5 3.8 3 3.772727273 4 6.812 26 7 5 4 4.545454545 3.666666667 11.383 31 8 4.6 3 4.14 4.33 8.619 14 9 4 3.5 4.23 4.67 4.51 26 10 4.2 4.5 3.73 1 4.89 12 11 5 1 3.86 1 8.55 58 12 4 3 4.27 4.33 6.993 35 13 5 4 4.68 6 6.837 30 14 4.2 3.5 3.95 4 6.59 23 15 4.842 28 16 5 4 4.59 6 5.269 23 17 5.97 13 18 4 3.5 4.14 3 6.712 32 19 1.4 2 2.54 5 6.386 50 21 4.2 3 3.68 5 7.913 51 22 2.6 3 3.5 3 6.212 34 23 7.459 45 24 4.2 3 3.77 4.67 8.366 45 25 3.4 2.5 3.18 5 5.392 29 26 3.6 3 3.77 4.33 13.785 44 27 2.6 3 3.32 3.67 17.075 36 29 4.8 5 4.72 5 7.308 39 30 3.8 3 3.73 3.33 15.604 21 31 2.6 3 3.36 4.3 10.552 50 32 4.4 4.5 4.59 6 6.658 15 33 4.4 4 4.23 4 6.466 5 34 3.2 4 3.77 3.33 1.479 15 35 3.6 3 3.77 2.67 10.243 41 36 4.2 3 3.91 4 12.106 31 37 3.6 3 3.5 6 12.737 77 38 4.2 4 4.36 5.33 9.309 26 39 2.6 4 2.86 4.33 38.213 100 40 4.4 3 3.83 3 8.773 45 41 5 4 4.55 1 10.807 46 42 3.8 5 4.59 6 9.441 20 43 3 4 3.5 4 4.795 31 44 4 3 3.73 4 10.777 41 45 4.6 5 4.64 6 10.59 24 46 5 3 4.27 3 2.259 10 47 4.2 4.5 4.59 5.33 6.94 27 48 4 4 4.09 4.67 12.332 49 50 4.2 4.5 4.64 5 5.127 17 51 5 3 4.36 3 5.594 31 52 3.4 4 3.59 3 8.789 36 53 4.2 4 4.09 5 7.717 20 55 4.2 3 3.77 3.33 6.862 37 56 4.4 5 4.32 5 3.13 22 57 4 3 3.77 4.67 16.121 26 59 4 3.5 4.14 6 4.958 34 61 4.6 4.5 4.68 6 14.51 32 62 4.6 3.5 4.41 5 4.953 15 63 4.6 3.5 4.41 5 10.058 18 65 5 4.5 4.5 5.33 1.151 8 66 4.8 5 4.82 3.33 0 33 67 4.4 4.5 4.5 5 10.027 15 68 4.6 3.5 4.32 6 3.56 23 69 4 2.5 3.5 5 4.678 24 71 4.8 4 4.64 1.33 8.311 10 72 4.2 3 4.27 6 5.272 26 73 4.2 4 4.14 5 6.378 16 74 4.6 5 4.14 3 9.313 0

TABLE-US-00003 TABLE 1C subjectid maxsm TS_XR CB_XR CLAV_ANG_XR TS_3D CB_3D CLAV_ANG_3D LATR 1 4 0 0 2.17 0 0 0.815 0 2 13 21 19 4.58 21.24497284 19.87635516 4.279 5.01 3 7 8 12 0.964 7.924862669 14.33294746 0.702 11.57 4 5 6 15 4.855 2.902637055 4.658700394 4.858 0 5 13 0 0 0 0 0 0 6.812 7 10 6 6 0.975 9.934577955 6.679008203 2.824 11.383 8 7 7 12 1.291 6.815532032 10.71012176 3.291 0 9 7 13 13 1.567 11.22517782 14.44199306 1.58 0 10 4 12 12 1.163 11.80346016 11.80346016 1.397 0 11 15 10 14 2.323 11.09939383 11.98393013 2.603 8.55 12 6 16 14 0.523 18.92617599 16.82326754 1.779 6.993 13 10 10 10 1.437 13.4922324 15.2979696 2.422 6.837 14 10 0 0 4.413 0 0 1.75 6.59 15 6 5 9 3.422 14.15531665 16.08457166 2.473 4.842 16 6 8 8 1.198 9.329931401 8.728582876 1.148 4.34 17 12 16 1.909 9.862989289 10.22791989 1.196 0 18 8 0 2.67 12.35095681 0 2.059 5.348 19 12 14 11 0 14.74143826 20.18208194 0 5.105 21 5 4 10 0 10.9647922 15.08389914 0 7.913 22 10 14 0 1.383 13.73430457 0 2.357 3.141 23 9 20 0 1.267 20.87553957 0 4.579 7.459 24 15 8 0 5.964 11.70546492 0 5.194 7.763 25 3 0 14 0 0 18.83037194 5.392 26 12 12 0 0 14.29768085 0 0 13.785 27 8 14 14 1.599 15.41829779 15.90204688 1.147 17.075 29 11 10 0 1.269 8.819908219 0 2.378 0 30 0 16 4.364 0 12.15131685 3.694 15.604 31 15 22 33 1.741 20.38831024 26.90327988 2.028 10.552 32 5 8 15 0.982 6.300114966 12.60022993 1.735 6.658 33 0 0 0 0 0 0 6.466 34 5 10 13 1.66 6.29109396 8.241333088 1.909 1.479 35 11 6 16 2.631 2.825482302 3.142878148 2.748 10.243 36 0 0 2.319 0 0 2.703 0 37 13 14 0 2.214 20.53690846 0 2.851 12.737 38 9 9 2.093 24.09674364 21.4791491 1.025 9.309 39 25 64 27 2.296 61.36533181 28.8805635 2.447 9.791 40 15 17 1.698 17.05100692 19.14528879 2.014 8.773 41 13 3 3 1.72 11.02200543 3.91483271 1.945 6.336 42 0 0 1.456 0 0 3.077 0 43 7.5 0 0 0.768 0 0 1.071 3.667 44 11 9 16 0.67 12.2599804 25.46303622 0.462 4.52 45 0 0 0 0 0 0 4.295 46 4 0 0 0 0 0 0 2.259 47 10 20 26 1.999 23.19755968 21.45130731 1.419 6.94 48 11 0 8 0.509 0 18.84031332 2.751 5.543 50 5 7 19 0 11.7715736 28.25177665 0 5.127 51 0 15 0.82 0 11.31510133 1.322 4.715 52 0 0 2.056 0 0 3.156 5.285 53 7 0 12 1.116 0 11.58589218 2.668 3.687 55 15 6 11 4.068 8.164482176 0 4.236 0 56 5 12 8 2.72 17.74399336 13.73442682 1.463 2.915 57 11 35 36 0.762 33.56457215 32.60558437 0.785 16.121 59 12 15 0.373 15.07928639 16.78037322 2.715 4.958 61 10 19 24 1.095 27.0488814 41.50031797 2.588 14.51 62 12 6 18 4.641 10.44332837 17.42730421 2.11 4.953 63 14 0 0 0 0 0 0 10.058 65 8 4 0 15.86992094 13.20190717 0 1.151 66 0 0 0.958 0 0 1.946 0 67 10 0 0 0.642 0 0 0.444 10.027 68 3.5 0 0 0 0 0 0 3.56 69 13 21 1.076 27.13072059 2.671 4.678 71 13 18 9 3.703 25.95944214 27.55595552 1.241 8.311 72 8 19 27 0.564 21.17693288 28.02969318 1.868 0 73 7.5 12 11 1.204 21.36180203 15.38018986 1.517 6.378 74 11 16 0.527 26.67779104 24.06803542 0.638 2.403

TABLE-US-00004 TABLE 1D subjectid LACA LSM_YN LSM L_DISP_DIFF L_DISP_DIFF_PER L_DIS_DIF L_DIS_DIF_PER 1 10 N 1.504230882 0.006302697 3.863254412 0.011598614 2 41 N 56.27847919 0.206004536 56.73723666 0.152441722 3 18 Y 7 16.29488182 0.070204833 35.18204112 0.106135573 4 5 N 1.743584914 0.00591863 5.86569681 0.011710865 5 26 Y 8 0.726511922 0.003043552 7.769991654 0.023500816 7 24 N 21.2614357 0.092253874 26.22846445 0.080734225 8 0 N 15.68015641 0.068498678 14.22125878 0.046581589 9 0 N 0.564648937 0.001818036 7.394077828 0.016670422 10 0 N 6.146666667 0.019169207 6.031416667 0.010486885 11 58 Y 15 62.15997415 0.189811689 73.58046034 0.147533948 12 35 N 35.76187363 0.137430509 41.9846312 0.123269707 13 30 Y 10 11.86420859 0.053431677 8.506941376 0.026916507 14 18 N 54.26496529 0.233500664 34.68271117 0.094970832 15 28 Y 6 25.96717433 0.090417254 43.74888307 0.112298391 16 14 N 3.743604057 0.015511989 10.81878028 0.033030119 17 0 N 18.89019727 0.078652435 6.931652149 0.02204762 18 15 N 24.38236585 0.07575611 9.914606471 0.017623399 19 25 N 32.59560931 0.095078791 36.16288884 0.065616535 21 51 Y 5 10.89860672 0.040388093 10.86383775 0.023675067 22 24 N 32.50043233 0.1249289 28.98625947 0.053150719 23 31 Y 3 30.2593242 0.133117363 33.50617423 0.110344812 24 43 Y 13 9.430406326 0.039004981 5.051258805 0.01326942 25 29 N 16.3154374 0.049374467 21.636631 0.04590789 26 33 N 11.38151152 0.045936288 9.772924561 0.031447498 27 30 Y 8 4.540659161 0.017258835 25.43437874 0.073557058 29 0 N 0 0 8.060943316 0.021434501 30 21 N 29.32223932 0.135671493 52.01316773 0.173559374 31 50 N 21.30539178 0.067647266 35.48913909 0.082516708 32 15 Y 5 9.199063903 0.041117604 4.049216735 0.014176342 33 5 N 19.21093829 0.077033517 25.97050038 0.07021429 34 15 N 0 0 1.54238175 0.003765567 35 41 Y 11 17.7066485 0.069627543 35.64908522 0.098837573 36 0 N 4.559925735 0.020154664 8.934648333 0.028161664 37 61 Y 10 1.011694805 0.003840951 15.8752372 0.045281618 38 26 N 0.488113036 0.001981692 6.10243411 0.017728203 39 58 N 4.13593427 0.020393558 28.896304 0.095462218 40 19 N 10.09739053 0.040991644 20.41951142 0.061206709 41 35 Y 12 2.807735553 0.011283398 7.579493728 0.022839147 42 0 N 3.2150265 0.012132257 1.559379347 0.004450459 43 19 N 3.696018735 0.014372193 7.770908145 0.024053947 44 30 N 13.99465479 0.051224488 15.23409443 0.038140751 45 20 N 31.50821789 0.125896971 39.8777763 0.090948718 46 10 N 9.426721978 0.03684413 5.745804843 0.016178329 47 27 Y 10 5.533463921 0.021093133 5.245947421 0.01506116 48 35 Y 8 19.08890691 0.078198836 2.037590662 0.005344866 50 17 Y 5 18.09250921 0.046871786 25.39826825 0.039271121 51 31 N 48.74906218 0.174565107 42.64453461 0.09919571 52 30 N 21.2554085 0.075356932 24.59286158 0.063634854 53 19 Y 5 2.807778831 0.009799021 6.680121652 0.014100921 55 0 N 10.66718543 0.03986552 12.16083037 0.032911696 56 18 N 5.973138034 0.025856069 4.752525111 0.013951422 57 33 Y 11 63.53204553 0.229201604 41.34224181 0.101495965 59 26 N 21.65814906 0.083214034 21.3853986 0.058285609 61 34 N 35.09703407 0.159304324 29.7015746 0.090602519 62 15 Y 7 22.35447652 0.095443552 25.31237264 0.070676069 63 15 Y 14 10.20969644 0.043613621 0.639318146 0.001950698 65 18 N 3.930267734 0.012485051 4.288307051 0.010917943 66 0 N 1.670471647 0.006730617 1.996794397 0.005914377 67 33 Y 5 9.9510188 0.037428124 7.077862158 0.020182677 68 0 N 114.3307529 0.193825422 64096.63734 0.989426105 69 23 Y 13 5.1325827 0.019655971 9.03527027 0.024631179 71 24 Y 2 17.58394183 0.070105517 23.37141668 0.069146708 72 0 Y 5 1.672681322 0.007005541 1.229981681 0.003640501 73 26 N 61.29931177 0.210081412 33.81047529 0.091768477 74 16 N 3.046184317 0.01075023 3.158420089 0.008242644

TABLE-US-00005 TABLE 1E subjectid L_AREA_DIF L_AREA_DIF_PER TATR TACA TSM_YN TSM T_DISP_DIFF 1 299.4014663 0.016962476 7.125 0 Y 4 39.70475183 2 5490.122215 0.260824295 16.641 49 Y 13 115.6213261 3 3215.54501 0.194714588 0 21 N 10.12752149 4 124.2015028 0.00357299 8.947 17 Y 5 17.27294815 5 997.7747927 0.058985483 0 0 Y 13 1.675475764 7 2438.980584 0.148634985 5.081 31 Y 10 12.61497775 8 1321.446949 0.091805111 8.619 14 Y 7 10.2023953 9 451.4610454 0.015577215 4.51 26 Y 7 1.871239441 10 178.4126914 0.003712155 4.89 12 Y 4 5.368104527 11 10024.32257 0.258671301 5.787 43 Y 8 10.34858905 12 3630.750167 0.224588665 5.51 17 Y 6 14.05261653 13 1206.775269 0.07922998 5.547 29 Y 10 12.95074168 14 3727.299165 0.185001706 5.996 23 Y 10 0.003816407 15 3176.16698 0.140823949 0 0 N 0.007502345 16 901.680915 0.057176577 5.269 23 Y 6 11.39837334 17 967.990283 0.065380446 5.97 13 N 9.796839664 18 2901.360538 0.059309002 6.712 32 N 9.550213681 19 7679.155741 0.16069271 6.386 50 Y 12 40.73533279 21 2025.740666 0.062878557 6.498 49 Y 5 8.206607678 22 5881.230233 0.145226342 6.212 34 Y 10 4.160756813 23 2742.176546 0.200108912 6.764 45 Y 9 14.00268005 24 670.4611013 0.03049252 8.366 45 Y 15 34.52040666 25 2975.590143 0.0890111 2.791 22 Y 3 33.25627312 26 1253.230446 0.091374246 9.092 44 Y 12 18.24344124 27 2400.861583 0.134039844 5.287 36 N 23.70096975 29 201.7236807 0.009306246 7.308 39 Y 11 18.60652308 30 3971.711508 0.292163628 0 0 N 0.00089634 31 4623.349774 0.16634382 4.665 31 Y 15 5.893665 32 141.64359 0.012108204 3.28 10 N 0.8388729 33 2527.457475 0.114799193 0 0 N 0.623628627 34 280.5209453 0.010538707 0 0 Y 5 6.703656076 35 3744.60316 0.187323339 3.59 32 N 2.002549616 36 338.7154806 0.021898739 12.106 31 N 11.80116798 37 1288.682264 0.072242346 8.567 77 Y 13 5.384301267 38 753.9166201 0.040643094 7.889 19 N 7.551367346 39 1889.785336 0.135465267 38.213 100 Y 25 99.9953253 40 2025.473297 0.123810051 6.579 45 N 5.136515814 41 491.9237072 0.031378799 10.807 46 Y 13 12.33287956 42 277.2461497 0.015030885 9.441 20 N 16.96653705 43 421.1082544 0.028172464 4.795 31 Y 7.5 12.62455213 44 2123.995332 0.084667719 10.777 41 Y 11 60.91677311 45 4987.943452 0.167497487 10.59 24 N 1.117083433 46 651.0329909 0.033460647 1.971 5 Y 4 14.22503692 47 1036.039202 0.056915963 4.645 24 N 30.12888513 48 126.4303048 0.006015182 12.332 49 Y 11 22.11999262 50 6587.921971 0.100184388 1.248 0 Y 0 0.37746114 51 4641.991842 0.164841324 5.594 29 N 17.7909287 52 2714.217197 0.118291543 8.789 36 N 7.947788524 53 724.7609648 0.020519911 7.717 20 Y 7 13.62079515 55 366.4262968 0.018468882 6.862 37 Y 15 4.29954801 56 623.4844582 0.034498834 3.13 22 Y 5 3.116937082 57 4255.967372 0.168637328 2.647 23 N 22.74191104 59 1652.128586 0.079964518 1.625 23 N 49.27727735 61 2521.82559 0.15141411 10.383 28 Y 10 15.35283574 62 2067.726725 0.103330001 4.025 32 Y 12 47.49235832 63 20.60632309 0.001252146 1.441 9 Y 5 3.475770795 65 690.5895708 0.032114851 0 0 N 2.629267788 66 200.9407234 0.011864145 0 8 N 4.448479346 67 25.30082261 0.001414232 5.903 30 Y 10 24.93183522 68 35758.351 1 3.554 15 Y 3.5 28.87717386 69 976.3524541 0.050917677 2.706 14 N 24.73444031 71 2585.986029 0.151257402 3.131 15 Y 13 25.68566847 72 135.575661 0.007750944 5.272 10 Y 8 15.63203413 73 2153.692923 0.117185844 2.716 21 N 7.5 18.96537664 74 265.5436466 0.012493827 9.313 16 N 41.67792217

TABLE-US-00006 TABLE 1F subjectid T_DISP_DIFF_PER T_DIS_DIF T_DIS_DIF_PER T_AREA_DIF T_AREA_DIF_PER 1 0.164561192 49.92077556 0.175143422 3036.331734 0.296639207 2 0.411290142 85.04272977 0.197286745 9945.55049 0.357566578 3 0.036145823 0.648363253 0.001672596 41.66018306 0.001838401 4 0.055071506 21.80122377 0.061468573 3103.248389 0.210727177 5 0.006753958 4.364891045 0.010622905 694.8489554 0.026375966 7 0.044993681 5.199765166 0.013145364 894.1647825 0.036787579 8 0.041710798 27.31899879 0.07809499 2332.868003 0.121862872 9 0.005161389 5.326341023 0.011655783 387.4126839 0.013180696 10 0.016953318 6.691011566 0.011903199 1837.936772 0.037136726 11 0.027021184 3.623105843 0.00682645 1236.902101 0.028503655 12 0.049602486 30.79853416 0.072267953 3848.216705 0.138201067 13 0.042565303 19.41021588 0.051529996 2187.702409 0.113146581 14 1.37452E-05 6.811332329 0.018262049 863.6567378 0.041745042 15 2.16028E-05 0.442638359 0.000906571 526.6684836 0.014175078 16 0.047645591 21.19990226 0.063177717 2117.185083 0.126027397 17 0.031490491 31.72403759 0.072330376 3380.669343 0.115137748 18 0.029095578 45.6909944 0.075094658 7206.954404 0.129837241 19 0.124320176 83.9469159 0.143664125 12261.5201 0.232901265 21 0.025228973 57.77520587 0.108713665 8203.464636 0.19570638 22 0.013606843 25.99383533 0.053041959 3918.837943 0.105226642 23 0.051991608 1.291308064 0.003610729 254.1149226 0.013120301 24 0.107513947 39.59133982 0.101719382 3824.584585 0.187066217 25 0.084733071 46.18362433 0.089358297 5380.779759 0.139856484 26 0.065011496 24.54589772 0.060735514 2663.196328 0.112615805 27 0.079866848 38.88138361 0.106888396 2696.134172 0.159374334 29 0.064142617 5.622769265 0.013656516 1764.869608 0.068367508 30 3.42465E-06 1.083227404 0.003101123 127.3430461 0.006907823 31 0.017260558 9.785998 0.022296675 1372.971357 0.049014956 32 0.002831591 1.023161061 0.002689537 565.525223 0.026566143 33 0.002012454 11.55532142 0.027904647 1951.634429 0.075511555 34 0.021218634 6.942626647 0.016561841 444.6106247 0.016836161 35 0.00690477 11.64438161 0.028594143 1058.205074 0.042516939 36 0.04473257 0.028300163 7.85719E-05 198.4450306 0.009879934 37 0.017297442 43.67876548 0.104880899 4118.079592 0.16798479 38 0.026275687 8.780974206 0.023904258 531.3480541 0.0263172 39 0.441610334 45.41015349 0.106275058 5843.96675 0.254352657 40 0.014984938 12.5950685 0.028411838 2108.613771 0.08974212 41 0.042796627 17.19703354 0.043138987 2585.307497 0.108208105 42 0.058378389 40.69510376 0.098900861 4269.223828 0.167384369 43 0.041261609 22.9697763 0.056164536 1864.119107 0.078834951 44 0.208254575 17.80105191 0.038813794 2461.177187 0.075722366 45 0.003634754 11.11546327 0.02723661 894.749058 0.035508958 46 0.048692761 5.465899967 0.013663826 369.9707555 0.015382935 47 0.091407242 22.44113353 0.053126291 2818.001036 0.111936766 48 0.070220711 38.08179556 0.088987993 4522.138049 0.16735417 50 0.001293654 4.197367876 0.011690496 561.9289414 0.033169616 51 0.054144934 28.81204811 0.066130362 3502.488448 0.130510473 52 0.026978746 27.37299632 0.062349639 3323.726956 0.117156358 53 0.040424585 22.54594595 0.049459425 3465.494536 0.113152184 55 0.013215335 21.2949447 0.053144555 2816.051227 0.13999081 56 0.010362684 2.080875949 0.005680228 275.23167 0.015425066 57 0.071257889 14.01409696 0.033647757 1062.342846 0.042226251 59 0.178814567 44.6507168 0.122925289 3579.865588 0.189520097 61 0.050567951 5.424805882 0.013207461 205.6651598 0.008171698 62 0.180518038 19.04042463 0.043749383 1985.531764 0.082207635 63 0.012585661 1.813678108 0.005095672 447.3564409 0.024518656 65 0.007267696 7.69302894 0.016504414 291.8225855 0.00946913 66 0.015636634 6.877349069 0.017543329 444.7806252 0.01902992 67 0.089673725 10.53756072 0.027138219 1096.798805 0.048468658 68 0.090423607 24.82690167 0.058758859 2542.644836 0.097849735 69 0.093933298 19.03508405 0.051117472 2516.071616 0.116672692 71 0.091783908 15.99884713 0.040305982 2142.802059 0.08929055 72 0.050337241 2.918903521 0.006963416 185.2057471 0.007100506 73 0.053079143 18.54578645 0.04321612 2217.622459 0.092276301 74 0.115360652 23.528081 0.050917796 1985.195184 0.063121208

TABLE-US-00007 TABLE 1G subjectid intervention_cat intervention_binary 1 2 0 2 4 1 3 3 1 4 2 0 5 3 1 7 3 1 8 2 0 9 3 1 10 2 0 11 4 1 12 3 1 13 3 1 14 3 1 15 3 1 16 3 1 17 2 0 18 3 1 19 4 1 21 4 1 22 3 1 23 4 1 24 4 1 25 3 1 26 4 1 27 3 1 29 3 1 30 3 1 31 4 1 32 2 0 33 1 0 34 2 0 35 4 1 36 3 1 37 4 1 38 3 1 39 4 1 40 4 1 41 4 1 42 3 1 43 3 1 44 4 1 45 3 1 46 2 0 47 3 1 48 4 1 50 2 0 51 3 1 52 3 1 53 3 1 55 3 1 56 3 1 57 3 1 59 3 1 61 3 1 62 2 0 63 2 0 65 1 0 66 3 1 67 2 0 68 3 1 69 3 1 71 2 0 72 3 1 73 2 0 74 1 0

TABLE-US-00008 TABLE 2 subjectid Unique identifier for Subject new Whether or Not Subject is New Patient age Age of Subject gender Gender of Subject srs_available Whether or Not SRS Scores are Available srs_pain_hm SRS Pain Score srs_appearance_hm SRS Appearance Score srs_activity_hm SRS Activity Score srs_mental_hm SRS Mental Score srs_satisfaction_hm SRS Satisfaction Score srs_tscore_hm SRS Total Score srs_hmscore SRS Heath Mindset Score maxATR Maximum Angle of Trunk Rotation maxcobb Maximum Cobb Score maxsm Maximum Scoliometer Measurement TS_XR Radiographic Trunk Shift CB_XR Radiographic Coronal Balance CLAV_ANG_XR Radiographic Clavicle Angle TS_3D 3D Scan Based Trunk Shift CB_3D 3D Scan Based Coronal Balance CLAV_ANG_3D 3D Scan Based Clavicle Angle LATR Lumbar Angle of Trunk Rotation LACA Lumbar Associated Cobb Angle LSM_YN Whether or Not a Lumber Spine Scoliometer Measurement is Available LSM Lumber Spine Scoliometer Measurement L_DISP_DIFF Lumbar Diff. Between Left and Right Displacements from Sagittal Line to Projection of Axis of Rotation on Horizon L_DISP_DIFF_PER Lumbar Diff. Between Left and Right Displacements from Sagittal Line to Projection of Axis of Rotation on Horizon as a % of Total Diameter L_DIS_DIF Lumbar Diff. Between Left and Right Circumferential Distance from Sagittal Line to Projection of Axis of Rotation on Horizon L_DIS_DIF_PER Lumbar Diff. Between Left and Right Circumferential Distance from Sagittal Line to Projection of Axis of Rotation on Horizon Line as a Percentage of Total Diameter L_AREA_DIF Lumbar Diff. Between Area of Left Upper Posterior Quadrant and Right Upper Posterior Quadrant L_AREA_DIF_PER Lumbar Diff. Between Area of Left Upper Posterior Quadrant and Right Upper Posterior Quadrant as a Percentage of Total Area in Posterior Hemisphere TATR Thoracic Angle of Trunk Rotation TACA Thoracic Associated Cobb Angle TSM_YN Whether or Not a Thoracic Spine Scoliometer Measurement is Available TSM Thoracic Spine Scoliometer Measurement T_DISP_DIFF Thoracic Diff. Between Left and Right Displacements from Sagittal Line to Projection of Axis of Rotation on Horizon T_DISP_DIFF_PER Thoracic Diff. Between Left and Right Displacements from Sagittal Line to Projection of Axis of Rotation on Horizon as a % of Total Diameter T_DIS_DIF Thoracic Diff. Between Left and Right Circumferential Distance from Sagittal Line to Projection of Axis of Rotation on Horizon T_DIS_DIF_PER Thoracic Diff. Between Left and Right Circumferential Distance from Sagittal Line to Projection of Axis of Rotation on Horizon as a % of Total Diameter T_AREA_DIF Thoracic Diff. Between Area of Left Upper Posterior Quadrant and Right Upper Posterior Quadrant T_AREA_DIF_PER Thoracic Diff. Between Area of Left Upper Posterior Quadrant and Right Upper Posterior Quadrant as a % of Total Area in Posterior Hemisphere intervention_cat 0 = No Intervention Necessary; 1 = Follow-Up, But No Intervention; 2 = Bracing; 3 = Surgery intervention_binary 1 = Any Intervention Necessary (Surgery or Bracing); 0 = No Intervention Necessary