ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biosensors and Biomolecular Electronics
Volume 13 - 2025 | doi: 10.3389/fbioe.2025.1629872
Time-of-Flight camera achieves high diagnostic accuracy in adolescent idiopathic scoliosis: a promising radiation-free alternative to radiography
Provisionally accepted
- 1Orthopedic and trauma surgery Department, CHU de la Milétrie, Poitiers, France
- 2Hôpitaux universitaires de Genève (HUG), Genève, Switzerland
- 3Department of Orthopedics Surgery and Traumatology, Clinique Porte Océane, Les Sables d’Olonne, France
- 4Institut Pprime UPR 3346, Centre National de Recherche Scientifique, Université de Poitiers, ISAE-ENSMA, Poitiers, France
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Background: The close monitoring of adolescent idiopathic scoliosis (AIS) population during the growing years is necessary and requires repetitive x-rays. This study aimed to evaluate the validity and test characteristics of time-of-flight (TOF) camera, a novel radiation-free tool, for assessing trunk asymmetry in patients with AIS. Methods: In this prospective diagnostic accuracy study, 94 AIS patients (10–18 years) underwent standardized TOF camera imaging (seated position), among whom 81 also received an angle of trunk rotation (ATR) assessment using a scoliometer (forward bending position). The average major Cobb angle in the cohort was 21.4°. The global trunk asymmetry (GTA) provided by the TOF-camera and the scoliometer-based angle of trunk rotation (ATR) were compared using a Pearson correlation with the gold standard major Cobb angle (CA) from 2D radiography (standing position). Receiver operating characteristic (ROC) analysis evaluated the diagnostic accuracy of GTA with the AIS diagnosis (CA>10°) and brace indication (CA>20°). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) values were reported and compared for GTA and ATR. Results: GTA was significantly correlated with the radiographic CA (p< 0.001). Considering scoliosis diagnosis (CA≥10°), AUC was 0.87 (0.79-0.96) for GTA (threshold=7°, Se=80%, Sp=80%) and 0.95 (0.9-1,0) for ATR. The AUC values of GTA and ATR were not significantly different (p=0.129), but sensitivity was significantly lower for GTA (76%) compared to ATR (91%). Considering a brace indication (CA≥20°), AUC was 0.92 (0.86-0.97) for GTA (threshold=7.87, Se =93%, Sp=76%). Conclusions: The TOF-camera seems to offer promising test characteristics for AIS diagnosis with high correlation to radiographic CA and competitive diagnostic accuracy versus scoliometer. While seated positioning may differ from standard radiographs, this approach enhances reproducibility and patient compliance. The high sensitivity and specificity of the TOF camera for scoliosis diagnosis highlight its potential as a safe, fast, and reliable alternative to X-ray imaging in routine clinical settings. It necessitates further investigations (solid screening characteristics, inter and intra-individual repeatability and validity) instead of repetitive radiographs to be used for monitoring the evolution of AIS in growing patients.
Keywords: time-of-flight-camera1, adolescent idiopathic scoliosis2, trunk asymmetry3, validation study4, gibbosity5
Received: 16 May 2025; Accepted: 13 Aug 2025.
Copyright: © 2025 Boché, Tabard-Fougère, Bazin, Severyns, Dayer and Vendeuvre. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anne Tabard-Fougère, Hôpitaux universitaires de Genève (HUG), Genève, Switzerland
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