Purpose: Free-breathing 4D dynamic MRI (dMRI) generates multiple regional respiratory endpoints, but identifying meaningful relationships between chest wall expansion and diaphragm motion can be challenging when examining many variables. This study presents a visualization-based framework using pair-plot coupling maps to reveal patterns of thoraco-diaphragmatic coordination in pediatric thoracic insufficiency syndrome (TIS). Methods: We analyzed 47 TIS patients (age 0.6-16.3 years) with paired pre-/post-operative dMRI after VEPTR surgery, alongside 200 healthy controls from the Virtual Growing Child (VGC) cohort. Regional endpoints included bilateral chest wall tidal volumes and territorial diaphragm motion (anterior, posterior, medial, central regions). Coupling maps were generated as matrix pair plots showing distributions, scatter plots, and Kendall t correlations for all variable pairs. Z-score standardization enabled age- adjusted interpretation. Results: Pre-operative coupling maps showed predominantly weak correlations (|t| < 0.2) between chest wall and diaphragm variables, indicating disrupted coordination. Post-operative maps revealed strengthened associations (t = 0.3-0.5 for key chest wall-diaphragm pairs, p < 0.001), particularly between chest wall expansion and posterior diaphragm motion. Visual comparison of pre/post maps provided immediate insight into coordination changes that would be difficult to extract from tables alone. Selected endpoints showed movement toward normative Z-scores post-operatively (mean improvement 1.2-1.8 SD units). Conclusion: Coupling maps offer an efficient visualization tool for understanding multivariate respiratory mechanics relationships in pediatric thoracic dMRI. The approach complements traditional endpoint reporting by revealing coordination patterns and their surgical response in a compact, interpretable format.

BACKGROUND:Dynamic, separate lung volume assessment during breathing is critical for evaluating thoracic disorders like scoliosis, thoracic insufficiency syndrome (TIS), and pulmonary diseases, as well as for monitoring treatments. While traditional volumetric assessment relies on static 3D imaging during breath-holds, this is unfeasible for many pediatric patients or those with severe respiratory distress. Free-breathing 4D dynamic MRI (dMRI) is the ideal modality due to its lack of radiation, excellent soft-tissue contrast, and flexible imaging planes. However, its clinical use is hampered by long acquisition times, during which patients struggle to maintain stable, consistent breathing patterns or remain still. Consequently, methods to accelerate dMRI acquisition while maintaining volumetric accuracy are urgently needed to make free-breathing assessments clinically practical. PURPOSE:We present an observational study involving free-breathing short-scan-time dynamic MRI (dMRI) method that can be routinely used for computing dynamic lung volumes accurately. METHODS:(1) Full sampled free-breathing sagittal 2D dMRI scans are gathered from 45 normal children via bSSFP sequence. Sparse dMRI (s-dMRI) scans are simulated from these datasets by optimally subsampling in the spatio-temporal domains via a limited number of selected sagittal locations and time instances. (2) A 4D image is constructed from both scans. Lungs are segmented from 4D image, and their volumes from full and sparse dMRI scans are computed. (3) A regression model is developed to predict full-scan volumes from sparse-scan data on a training set. (4) The accuracy is analyzed on both synthesized sparse dMRI scans from a separate fully-sampled-scan test set and actual s-dMRI scans prospectively acquired from 10 normal children. RESULTS:With 5 slices per lung and 40 time points, the predicted volume showed a ∼2% deviation from the full-scan volume, with a total scan-time of ∼9 min (vs. 49.72 ± 5.01 min for the full scan with 15-22 slices per lung and 80 time points). When the spatial sampling was increased to full number of slices (15-22 per lung) but only 40 time points, these metrics become 0.4%, and 24.86 ± 2.5 min. CONCLUSIONS:s-dMRI is a practical approach for computing dynamic lung volumes that can be used routinely with no radiation concern, especially on patients who cannot tolerate long acquisition times.

Background Tether breakage is a significant complication that can occur when performing vertebral body tethering (VBT) in patients with adolescent idiopathic scoliosis (AIS). While previous studies have reported tether breakage rates, the incidence of tether breakage across medical device manufacturers and VBT models remains unknown. This study aims to define the rate of tether breakage in second-generation device systems compared with their first-generation counterparts. Methods: A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with AIS treated from 2011 to 2021 who underwent thoracic VBT with at least 2 years of follow-up. Radiographic tether breakage, as defined by an increase in adjacent screw angle >5 degrees during the postoperative period, was analyzed across the first-generation and the second-generation vertebral body tethering devices from within the same product line. Wilcoxon rank tests and Fisher’s exact tests were performed to compare differences across cohorts. Results: Two hundred thirty-one patients across 12 centers were included in the final analysis. One hundred seventy-nine patients received first-generation implants from 2011 to 2018, and 52 patients from 2017 to 2021 received second-generation vertebral body tethering devices. In total, radiographically identified tether breakage occurred in 116 patients (50%). The rate of radiographic tether breakage did not differ across generations (52% vs. 44%; P =0.46). Four patients (8%) who received the newer VBT system underwent revision compared with 15 patients (8%) who were implanted with first-generation instrumentation ( P =0.87). In addition, only 1 patient (2%) who received the second-generation device and 8 patients (4%) who received the older VBT system were converted to posterior spinal fusion within 2 years of index surgery ( P =0.69). Interestingly, the surgeon observed rate of tether breakage significantly decreased from the first generation of VBT devices to the second (21% vs. 2%; P <0.001). Conclusion: Tether breakage remains high in cases when using the new tether devices and is comparable to rates observed with the older models, despite lower rates of surgeon-reported breakage. Level of Evidence Level III.

AIS is a 3D deformity characterized by vertebral body rotation, often quantified by the angle of trunk rotation (ATR). However, there is not necessarily a linear relationship between ATR and Cobb angle. We aimed to examine demographic factors that affect this association. Initially, univariate and multiple linear regression compared ATR and Cobb angle in 4329 AIS patients. Given marked differences between Black patients and other racial groups in the thoracic region, we repeated our analysis after dichotomizing patients. Males and females were also compared in the thoracic and lumbar regions. For BMI and age, we repeated these analyses, including BMI and age as interaction terms in each regression. A sample of 4329 AIS patients had mean age 12.7 ± 2.3 years (1–21 years) for patients with available data. Mean age at the time of Cobb angle and ATR measurements was 15.0 ± 2.2 years (9.6–26.5 years) for 4326 patients with available data for date of birth and visit date. Among 4262 patients with available thoracic scoliometer measurements of 35 degrees or less, the mean thoracic Cobb angle was 54.0 ± 15.0 degrees (0–127 degrees), and the mean thoracic rib hump angle was 13.8 ± 5.8 degrees (0–33 degrees). Among 4054 patients with available lumbar scoliometer measurements of 35 degrees or less, the mean lumbar Cobb angle was 40.9 ± 13.8 degrees (4–110 degrees) and the mean lumbar rib hump angle was 8.3 ± 5.7 degrees (0–30 degrees). The mean BMI was 21.5 ± 4.4 (10.6–39.8) for 3890 patients with available data. After dichotomizing patients, black patients’ slope was 0.3 and 0.2 less than other groups when using univariate (p = 0.01) and multiple linear regression (p = 0.04), respectively. Females demonstrated a significantly greater slope than males in the thoracic region and significantly lesser slope in the lumbar region when using both univariate and multiple linear regression. With each point increase in BMI, thoracic slope decreased by 0.03 for both univariate (p = 0.001) and multiple (p = 0.002) linear regression. The relationship between ATR and coronal curvature varies significantly by race, sex, and BMI. In particular, Black patients demonstrate lower thoracic curves for the same ATR measurements. Females demonstrate greater curves at lower ATR measures in the thoracic region, and males demonstrate greater curves in the lumbar regions. As BMI increases, the slope between thoracic ATR and Cobb angle decreases.

We present a technical framework for integrating breathing frequency into regional volumetric analysis of free-breathing 4D dynamic MRI in pediatric populations. Regional quantitative MRI endpoints traditionally focused on tidal volume amplitudes but did not capture breathing rate, which varies substantially with age and respiratory state. We describe implementation of frequency normalized regional metrics (RR/TV ratios) alongside standard regional volumetric measures, using Z-score standardization against age-matched reference data. This approach is demonstrated in 47 pediatric thoracic insufficiency syndrome (TIS) patients with paired pre/post-VEPTR surgery scans, compared to 200 healthy controls. Technical components include respiratory rate derived during 4D reconstruction via the OFx method, regional volumetry of lung compartments, and reference space normalization using the Virtual Growing Child (VGC) normative database. We show that frequency weighted outcomes exhibit stronger developmental trends (Spearman. = -0.54 for lung RR/TV vs. +0.40 to +0.44 for lung volumes) and larger effect sizes when tracking surgical changes (r = 0.54-0.64 for RR/TV vs. r = 0.66-0.83 for TV). The framework can be integrated into existing 4D-MRI pipelines with minimal overhead and provide a more complete characterization of breathing mechanics in pediatric chest wall disorders.

Background: Asphyxiating thoracic dystrophy (ATD), or Jeune syndrome, is a rare skeletal dysplasia marked by a severe hypoplastic chest wall and restrictive lung disease, leading to an often-lethal thoracic insufficiency syndrome. Early-onset scoliosis (EOS) can complicate ATD, but details of operative management remain limited. This study aims to analyze the peri- and postoperative course of children with ATD who underwent posterior spinal fusion (PSF). Methods: A retrospective review was conducted for all patients with ATD treated for EOS who underwent PSF at our institution. Preoperative spinal deformity at the time of definitive fusion and prior growth-friendly procedures were assessed. Intra- and postoperative data, including instrumentation levels, operative time, estimated blood loss, hospital and ICU stay, and complications, were collected and analyzed descriptively. Results: Six patients met inclusion criteria. Five had previous expansion thoracoplasties with VEPTR instrumentation; median age at first surgery was 9 months. Median age at scoliosis onset and PSF was 35 months and 14 years, respectively. Median preoperative major coronal curve was 60 degrees. The sagittal profile ranged from severe lordosis to hyperkyphotic. Three patients had VEPTR instrumentation at the time of PSF. The most common upper instrumented vertebra was T2, and the lowest instrumented level ranged from T12 to L4. Median estimated blood loss was 500 mL with 175 mL of autologous blood salvage. Two patients required intraoperative blood transfusions. Median intensive care unit and total hospitalization were 4 and 6 days, respectively. Using the modified Clavien-Dindo-Sink classification system, 1 patient had a grade 0, 1 had a grade I, and 1 had a grade IIIb complication due to an emergency bronchoscopy. Conclusions: ATD is well-known for resulting in thoracic insufficiency syndrome due to a volumetric decrease of the thoracic cage. This series indicates that ATD is not unlike other pediatric non-idiopathic scoliosis undergoing PSF. Despite the pulmonary complexity and history of multiple prior thoracic cage procedures, ATD patients can and should safely undergo spinal deformity correction if indicated. Levels of Evidence: Level IV.

BACKGROUND:New drugs, devices, and other tools are essential to improving children's orthopaedic care. An often underappreciated aspect of new products is the amount of time and money needed to bring them to the bedside. While grants and other seed money have a role very early in the development of technology by start-ups, the bulk of the expense of such development is borne by private investors. METHODS:We examined a quarter century of early-stage investments in pediatric orthopaedic start-ups and compared them with similar investments in adult-focused orthopaedic companies. RESULTS:Investor backing of pediatric enterprises was much less common, representing only 10% of investments in the field of orthopaedics. Yet, when pediatric companies were supported, the rate at which they acquired subsequent capital and the total amount of capital they raised were comparable with those of adult-focused companies. CONCLUSIONS:Investments in new pediatric orthopaedic innovations from 2000 to 2024 were far less common than adult orthopaedic investments. Our data underscore the unmet challenges of backing start-ups in the field and provide benchmark data against which founders and investors can judge their financial performance. CLINICAL RELEVANCE:The availability of new orthopaedic tools is tied to capital investment in the field's youngest companies. A more complete understanding of long-term trends in the private financing of pediatric orthopaedic start-ups is essential for founders, investors, and policymakers.

» The Food and Drug Administration (FDA) was created in the wake of public outcry generated by Upton Sinclair's The Jungle. The FDA gained further regulatory authority following successive public health setbacks in the 20th century. » A full review for a new device is referred to as a premarket approval (PMA), while an application for a device based on a predicate is referred to as a premarket notification (PMN) better known as a 510k. » Both for PMNs and PMAs the costs and timelines typically far exceed the statutory limits imposed by congress, running into years of review and many millions of dollars. » Real-world data (RWD) can now be used to generate evidence for use in regulatory applications; this change will hopefully reduce the cost and time-to-market for new medical devices. » RWD has significant limitations such as bias, confounding, missing data, and privacy concerns that will require the FDA to take a fit-to-purpose approach for applications using RWD.

Congenital myopathy (CM) is a group of rare genetic disorders characterized by hypotonia, hyporeflexia, and weakness present at birth. The condition is estimated to affect between 0.7 and 4.4 per 100,000 children. Synthesizing physical exam findings, magnetic resonance imaging results, muscle biopsy morphology, and genetic testing results is necessary to reach a specific CM sub-diagnosis. Major forms of CM include nemaline myopathy, core myopathies, and centronuclear myopathies. CM diagnoses can lead to the onset of scoliosis as well as a host of other neurological, cardiological, and pulmonological comorbidities. Patients often are required to consult a wide variety of clinical specialties to obtain appropriate care for this condition. Orthopedic pathologies, including congenital hip dysplasia, ligamentous laxity, and early onset scoliosis (EOS), are common in CM patients. EOS is particularly severe in SEPN1- and ryanodine receptor (RYR1)-related myopathies, often necessitating nighttime respiratory support and surgical correction. While not many patients diagnosed with CM will require surgical intervention, research indicates that outcomes following surgery are similar for patients with other neuromuscular conditions across growth-friendly (GF) techniques like vertical expander prosthetic titanium rib, traditional growing rods, and magnetically controlled growing rods. Further investigation is needed to understand the full risk profile of performing surgery in patients with congenital myopathies.

Background:Vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS) is an alternative to posterior fusion. There are limited prospective, multicenter data available on VBT following US Food and Drug Administration approval. We hypothesize that curve correction on first postoperative standing (first erect, FE) imaging is associated with higher rates of successful correction at final follow-up. Methods:All qualifying patients with AIS who underwent thoracic and lumbar VBT between 2019 and 2022 were prospectively enrolled from 9 institutions. Radiographic and clinical data were compared preoperatively, at FE, and at final follow-up with minimum of 2 years. Success was defined as major curve magnitude of ≤35° at final follow-up and no fusion surgery. Results:One hundred twenty-seven patients were enrolled (79.5% female), with mean follow-up 2.4 years. Mean age at surgery was 12.9 ± 1.4 years, most had bone age of Sanders 4 or lower (93/112, 83.0%). In average, 7.6 ± 1.7 levels were tethered. Mean preoperative major curve magnitude was 50 ± 8°, with mean initial correction at FE of 29 ± 8° (% correction, 39 ± 18%). At final follow-up, mean curve magnitude was maintained at 26 ± 11° (% correction, 45 ± 23%) despite 29% of tether breakage. Patients who had mean FE curve magnitude of ≤35° were 88% successful compared with only 60% in those with >35° on FE (p = 0.0021). Patients showed stable sagittal alignment across all timepoints. Scoliosis Research Society-22 scores improved significantly by 2 years (p < 0.0001). Conclusion:This was the first prospective, multicenter study to assess outcomes of VBT for patients with AIS. VBT shows promise, but optimal results may depend on careful patient selection and surgical technique. FE major curve magnitude of ≤35° was associated with 88% success rate compared with only 60% success for those with poor correction. Level of Evidence:Level II. See Instructions for Authors for a complete description of levels of evidence.

Purpose To quantify regional respiratory function using four-dimensional free-breathing dynamic MRI (dMRI) and evaluate vertical expandable prosthetic titanium rib surgery impact on diaphragm curvature in pediatric thoracic insufficiency syndrome (TIS) using pre- and postoperative and control comparisons. Materials and Methods Curvature was retrospectively analyzed in 149 pediatric patients with TIS from May 2010 to November 2022 (49 pre- and postoperative, 70 preoperative-only, 30 postoperative-only dMRI) and compared with 190 controls. Mean follow-up ± SD was 2.4 years ± 1.8. Diaphragm contours were delineated at end-expiration and end-inspiration, and curvature was quantified across 13 regions per hemidiaphragm. Analyses included paired t tests, one-way analysis of variance to compare with controls, and correlation analyses relating postoperative curvature to ventilatory status and thoracic Cobb angle. Results Patients with TIS (mean age, 3.5 years ± 3.5; 27 male) demonstrated region-, plane-, and phase-dependent preoperative curvature differences compared with controls (mean age, 11.9 years ± 3.6; 92 male). Significant pre- to postoperative curvature changes were limited to five region-plane-phase combinations. The right hemidiaphragm anterior-lateral region at end-expiration showed the only sagittal-plane change (6.3 m-1 ± 0.7 to 8.2 m-1 ± 0.6, P = .02), approaching control values (9.3 m-1 ± 2.6). Several regions were no longer different from controls, most prominently in the right hemidiaphragm coronal plane at end-inspiration, whereas others, particularly sagittal end-inspiration regions, remained different (P < .05). Postoperative curvature correlated with ventilatory status, strongest in central sagittal regions (ρ ≤ 0.392, P < .001), and with thoracic Cobb angle in posterior sagittal regions (ρ ≤ 0.385, P < .001). Conclusion Surgery resulted in plane- and phase-specific improvements in diaphragm curvature, with partial normalization toward control values predominantly in coronal-plane regions. Keywords: Pediatrics, MR-Functional Lung Imaging, MR-Imaging, Pulmonary, Diaphragm, Anatomy, Treatment Effects, Outcomes Analysis, Comparative Studies, Curvature, Dynamic MRI, Quantitative Radiology, Shape, Thoracic Insufficiency Syndrome (TIS) Supplemental material is available for this article. © RSNA, 2026.

Thoracic insufficiency syndrome (TIS) and early-onset scoliosis (EOS) are complex pediatric conditions involving deformities of the spine and chest wall, which can significantly impact respiratory function and overall development. Managing these conditions requires a comprehensive approach that combines precise diagnosis and innovative treatment strategies. This opinion article provides a critical discussion of the diagnosis and treatment of TIS and EOS and reflects upon the advancement of methods that are crucial for assessing these conditions and guiding treatment decisions.

BACKGROUND:Surgical intervention for scoliosis in the cerebral palsy (CP) population is associated with high rates of postoperative complications. Research regarding whether complications after spinal fusion for CP scoliosis patients affect long-term health-related quality of life (HRQOL) remains limited. The goal of this study was to determine if CP scoliosis patients with major postoperative complications have worse HRQOL 2 years after surgery. MATERIALS AND METHODS:A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with nonambulatory CP treated with spinal fusion from 2008 to 2019 with at least 2 years of follow-up. HRQOL was measured through the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Complications included anything life-threatening, extended hospitalization, spinal cord/nerve injury, or reoperation. Complications were also classified as "existing" or "resolved" based on the 2-year postoperative visit. Patients with existing or unresolved complications at the 2-year postoperative visit were excluded. RESULTS:There were 298 CP patients operated on during the study period (51% male, mean age: 14.3±3 y). Within this cohort, 208 patients (70.0%) were identified as GMFCS V. 76 patients (26%) experienced a postoperative complication. Seventy-one patients (93%) had a complication that resolved by 2 years postoperatively. Five patients (7%) had complications that did not resolve and required ongoing treatment. The most common complication was infection (13%). There was no difference in CPCHILD total, as well as domain HRQOL scores at 2 years postoperatively between patients without complications and patients with resolved complications ( P >0.05). Similarly, there was no difference in mean improvements in CPCHILD total and domain scores at 2 years postoperatively between the no complication and resolved complication cohorts ( P >0.05). CONCLUSION:Patients with CP scoliosis who experience postoperative complications that resolved by 2 years postoperatively have no significant difference in HRQOL in comparison to those without postoperative complications as measured through the CPCHILD questionnaire. Patients and surgeons can be reassured that despite a high complication rate in CP scoliosis surgery, the initial expectations of improved HRQOL are not diminished as long as the complication is appropriately identified and managed. LEVEL OF EVIDENCE:Level III.

MAGEC growing rods are part of a new surgical treatment for children with severe spinal deformities. Pre-treatment and post-treatment evaluation for the operation is crucial, particularly for assessing respiratory volumes. Various modalities can be used for volume measurements, including spirometry, chest radiography (CXR), chest computed tomography (CT), and chest magnetic resonance imaging (MRI). Due to the limitations in patient ability and cooperation, breath-holding is not possible, making routine CT examinations and other techniques difficult for volumetric measurement. Ideally, dynamic MRI (dMRI) can be used to measure volumes in patients. However, after surgery, the presence of magnetic elements in MAGEC rods precludes MRI scanning. Therefore, finding a method to measure regional respiratory volumes in patients with MAGEC rods is essential for optimized clinical care. In this paper, we propose a novel method using pre-operative dMRI scans and pre- and post-operative CXR images to predict post-operative lung volumes via a neural network without the need for post-operative MRI scans. We used a limited dataset of 49 pediatric patients with thoracic insufficiency syndrome (TIS) who underwent treatment with traditional VEPTR surgery for this study, and demonstrated the feasibility of predicting post-operative lung volumes with results of around 10% relative percentage error. We believe that future prospective studies which enable collection of more datasets may allow the prediction framework to achieve accuracy that is adequate for the application at hand to assess the outcomes of less invasive surgical procedures.

One factor that may lead to the development of early-onset scoliosis (EOS) is chest wall procedures during infancy, which are common for patients with Trisomy 21 requiring cardiothoracic intervention involving thoracotomies. Studies examining scoliosis incidence in patients with prior thoracotomy demonstrate a wide incidence range. Our study aimed to assess if scoliosis prevalence is higher in patients with Trisomy 21 who underwent prior thoracotomy compared to patients who underwent sternotomy for congenital heart disease repair. An IRB-approved, single-center retrospective review included patients aged 9 years or older with Trisomy 21 who underwent prior cardiothoracic surgery. Exclusion criteria included other trisomy diagnoses, no cardiothoracic surgical history, unavailable operative records, and ages 0–8 years. Medical chart review examined demographics, surgical details, and scoliosis diagnosis and management. Statistical analyses included chi-square, z test, one-way ANOVA, and descriptive statistics. Of 301 total patients, 12.6

PURPOSE:Dynamic magnetic resonance imaging (dMRI) is a practical imaging modality for capturing information about regional thoracic-abdominal components and their dynamics in healthy children and pediatric patients with thoracic insufficiency syndrome (TIS). We propose an auto-segmentation set-up for the lungs, kidneys, liver, spleen, and thoraco-abdominal skin outer boundary (Skn) in dMRI images. METHODS:The segmentation setup has been implemented in two steps, recognition and delineation, using two deep neural network (DL) architectures, DL-R and DL-D for the recognition and delineation steps, respectively. The encoder-decoder framework in DL-D utilizes features at four different resolution levels to counter the challenges involved in segmentation. dMRI sagittal slice acquisitions of 189 (near-)normal subjects were evaluated, with an in-plane spatial resolution of roughly 1 × 1 mm2 with 6.00 mm spacing between slices. We utilized images from 89 and 10 subjects at end inspiration for training and validation, respectively. For testing, we experimented with three scenarios utilizing: (1) the images of the 90 (=189-89-10) remaining subjects at end inspiration for testing, (2) the images of the remaining 90 subjects at end expiration for testing, and (3) the images of the other 99 (=89+10) subjects at end expiration for testing. In some situations, we can take advantage of the already available ground truth (GT) segmentation for an object in a subject at a particular respiratory phase to automatically segment the same object in the same subject at a different respiratory phase, and then refine the segmentation to create the final GT for all respiratory phases in the image of a subject. We anticipate that this process of creating GT would require minimal post hoc correction. In this spirit, we conducted separate experiments where we assumed to have GT of test subjects at the end expiration for scenario (1), end inspiration for (2), and end inspiration for (3). A major contribution in this paper is the different scenarios of training and testing that we have extensively evaluated with respect to respiratory phases and the subjects to which the images in the training and testing sets belong. RESULTS:Among these three scenarios of testing, for DL-R, we achieve the best average location error (LE) of about 1 voxel for the lungs, kidneys, and spleen, and 1.5 voxels for the liver and Skn. The standard deviation (SD) of LE is about 1 or 2 voxels. For DL-D, we achieve an average Dice coefficient (DC) of about 0.92 to 0.94 for the lungs, 0.82 for the kidneys, 0.90 for the liver, 0.81 for the spleen, and 0.93 for Skn. The SD of DC is lower (0.02 to 0.07) for the lungs, liver, and Skn and slightly higher (0.06 to 0.12) for the spleen and kidneys. CONCLUSIONS:Motivated by applications in surgical planning for disorders such as TIS, adolescent idiopathic scoliosis, and early onset scoliosis, we have created an auto-segmentation system for thoraco-abdominal organs in dMRI acquisitions. This proposed setup copes with the challenges posed by low resolution, motion blur, inadequate contrast, and image intensity non-standardness in dMRI images quite well.