## 4 Discussion  
The purpose of this systematic review study was to evaluate the technique or mechanism for diagnosing scoliosis by examining the characteristics and metrics that are frequently employed in imaging. Analyzing the advantages and disadvantages of parameters employed in each inquiry in depth is necessary to comprehend the assessment mechanism to find possible accurate diagnostic methods. Seventeen publications were considered in the current study for thorough review. Quality evaluation functioned as the primary methodological consideration to address the inconsistent methodological reporting by ensuring that the constraints of the examined research were considered. None of the articles that were assessed received a score below 70%, which was regarded as the acceptable average. Participants' characteristics, parameters/landmarks, assessment methods, modalities, software, and instruments utilized in the research outcomes may all be further examined in the evaluated articles. The data characteristics were varied, and there was a propensity to group data according to gender, quantity, and the details of the data (age, inclusion criteria, and exclusion criteria); thus, it limited the analysis for certain groups in this reviewed paper. The dataset suggested has a broader range of ages and is not limited to adolescents and a young age. This is because scoliosis can happen to all generations. From the details provided of the data used in the studies, most of the data confirmed have a scoliosis diagnosis from the clinicians. Thus, it is proposed to use data that do not have confirmation of scoliosis by the clinicians for variability. As we can see, researchers have established several useful methods for diagnosing scoliosis deformity. Choosing appropriate factors, such as the instrumentation, imaging modality, and parameter or landmark evaluation, is crucial to the success of the study. In this review, most methods focus on two-dimensional or one-dimensional views, and just a few use three-dimensional views for their data. A recent study of scoliosis deformity assessment has an interest in the three-dimensional view because it gives a better and more specific view of the spine so that clinicians can grasp an accurate diagnosis of scoliosis. A three-dimensional view gives an image of the spine in three positions which are the frontal, sagittal, and transverse, which is far better compared to others because it can clearly show the abnormal angle rotation of the scoliosis that cannot be viewed in the frontal plane. The one-view plane, which is the frontal plane, is suitable for quick, early spinal deformities, but this cannot give specific and accurate information about the curve severity and the spine deformities angle. This is quite significant in decision-making by the clinicians for the follow-up treatment. Next, various parameters or landmark evaluations in scoliosis detection were utilized in their studies. The Cobb angle is the most common metric in determining the level of scoliosis that categorizes a person as having mild, moderate, or severe scoliosis. It is also quite simple and easier for computation for all assessment approaches whether in image processing or artificial intelligence since it is just calculating angles from two points of abnormal spine curvature; however, this can be implemented in the frontal plane only. Next, the Scolioscan angle, DIPA, and 3D scoliosis angle are the improvement metrics adapted from the Cobb angle that significantly exerts evaluation in diagnosing because they are evaluated in a three-dimensional view and have the same diagnosis concept as the Cobb angle. Metrics that evaluate the curve severity of the spine by utilizing points or coordinates on the spine, such as the BAI and extreme points or 3D coordinates, exert specific diagnosis values in the curvature of the spine. Identifying the curvature severity of the spine can aid clinicians in planning treatment accurately rather than just categorizing patients into mild, moderate, and severe categories.