PurposeScoliosis is a prevalent spine deformity that impacts millions of children globally. The Cobb angle, a crucial and widely-accepted metric, serves as the "gold standard" for assessing scoliosis in patients. However, the traditional manual measurement of spine curvature is time-consuming and labor-intensive. It also comes with issues like intra - and inter-observer variations. Moreover, accurately and robustly evaluating Cobb angles is extremely challenging. This is because it necessitates the correct identification of all the required vertebrae in both the anterior-posterior (AP) and lateral (LAT) views of full-spine digital radiography (DR).MethodsTo solve these challenges, a deep learning-based framework is developed to fully automatically measure patient Cobb angels from full-spine DR of both AP and LAT views. First, a deep learning network was used to distinguish AP and LAT views. Then the region of interest (ROI) of the whole spine was located and extracted. Subsequently, a detection network was applied to detect and identify the boundaries and locations, the types, and the four corner points of each spinal vertebra. Finally, the Cobb angles was measured automatically. When taking into account the location, recognition, and key points detection of spinal vertebrae, YOLOv8 architecture with CBAM module was adopted as the backbone.ResultsA total of 1,163 AP view and 1,378 LAT view DR images were used to train and evaluate the models. Experimental results in the evaluation testing showed a mean Cobb angle error of 2.56 degrees for AP view and 2.498 degrees for LAT view DR images. The intra-class correlation coefficient (ICC) with 95% confidence interval (CI) was 0.956 (0.932, 0.972) for AP view and 0.925 (0.888, 0.952) for LAT view. The Pearson correlation coefficient was 0.961 for AP view and 0.930 for LAT view. In the comprehensive reader study, for the major curve, a mean Cobb angle error of 3.918 degrees, an ICC of 0.943 (0.912, 0.965), and a high correlation coefficient of 0.960 were obtained.ConclusionThe results showed that the proposed framework had a significant accuracy and consistency advantage in measuring Cobb angle, which not only validated the effectiveness of the algorithm, but also provided strong support for the diagnosis of clinicians.