Original ResearchRadiographic Angles in Hallux Valgus: Comparison between Manual and Computer-Assisted Measurements
Section snippets
Objectives
The main objective of this study was to compare the inter- and intraobserver reliability between manual measurements using marker pen and goniometer, and computer-assisted measurements of digitized images using software, for radiographic angles in hallux valgus (HVA, IMA, DMAA, and IPA). The secondary objective was to compare the time taken between these 2 methods.
Study design
This observational study was conducted at Stafford General Hospitals NHS Trust, after approval from the local research and ethics committee (LREC).
Selection of radiographs
Thirty radiographs performed preoperatively for patients with hallux valgus deformity seen in an outpatient clinic in January 2007 were used in this study. The radiographs had been taken using standard technique with the patients weight bearing, 15-degree angulation of the x-ray tube toward the ankle, and centered on the midfoot. All identifying
Intraobserver data
The intraobserver error was assessed by calculating the TEM for the 3 observers (Table 2). The intraobserver error was less with the computer-assisted method for all 4 angles, including the DMAA. The TEM (observer 1) improved from 2.32 to 2.24 for HVA, 1.9 to 1.33 for IMA, 3.9 to 2.97 for DMAA, and 2.03 to 1.84 for IPA. Furthermore, the error was reduced for the other 2 observers, including observer 3 who had the least experience and skill level in performing angular measurements for hallux
Discussion
Radiographic angles are measured to assess severity of deformity, choose type of surgical procedure, assess postoperative correction, and compare results. The use of angular measurements is based on the belief that they are reliable, repeatable, and provide a constant value for comparison with other studies. The traditional method of measuring angles on plain radiographs is by using marker pens, placing reference points, identifying axis of the respective bones, and measuring angles with a
Acknowledgment
The authors acknowledge the technical assistance provided by Dr Chi-Wen Lung.
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