Who Interprets Scoliosis X-rays
Scoliosis x-ray series are formally interpreted by radiologists, but orthopedic surgeons provide the clinically meaningful interpretation that drives treatment decisions, as radiologists often fail to document critical parameters needed for scoliosis management.
Standard Practice Pattern
Radiologist's Role
- Radiologists provide the official radiology report for scoliosis x-rays as part of standard medical imaging protocols 1.
- However, radiologists frequently omit critical information needed for scoliosis management, including curve magnitude (mentioned in only 12.6% of reports), curve type (5% of reports), curve levels (10.6% of reports), and progression assessment (16.7% of reports) 2.
- When radiologists do provide additional information beyond what orthopedic surgeons document, 36.8% of this information is incorrectly read or mislabeled 2.
Orthopedic Surgeon's Role
- Orthopedic spine surgeons perform their own independent interpretation of scoliosis radiographs, documenting curve magnitude in 98.1% of cases, curve type in 99.4%, curve levels in 95.6%, and progression in 98.4% of cases 2.
- Surgeons' interpretations directly inform treatment decisions including observation, bracing (for curves 25-40°), and surgical intervention (typically for curves >50°) 3, 4.
- The orthopedic surgeon's interpretation is essential because radiologists gained little useful information in their duplicate readings, with only 1.9% additional information provided, most of which lacked clinical significance 2.
Clinical Implications
Accuracy Concerns
- Community radiologist interpretations have significant limitations, with only 65.8% accuracy in detecting brace candidates (curves 25-40°) 5.
- The false negative rate is 34.6%, meaning one-third of patients who need bracing are missed due to underestimation of Cobb angles by radiologists 5.
- This results in 32.7% of brace candidates being missed because of underestimation in Cobb angle measurements 5.
Practical Workflow
- Both specialists review the images, but the orthopedic surgeon's interpretation is definitive for clinical decision-making 2.
- Radiologists should document detailed findings including curve magnitude, type, levels, and progression, though this rarely occurs in practice 2.
- The radiologist's report serves primarily as a screening tool, while the surgeon's measurements and classification guide actual treatment 6, 7.
Key Pitfall to Avoid
Never rely solely on the radiologist's report for scoliosis management decisions - orthopedic surgeons must independently measure Cobb angles, assess curve type and levels, and evaluate progression, as radiologist reports frequently lack the specific parameters required for treatment planning 2, 5.