Accuracy of Automatic Cephalometric Software on Landmark Identification

This study was to assess the accuracy of an automatic cephalometric analysis software in the identification of cephalometric landmarks. Thirty randomly selected digital lateral cephalograms of patients undergoing orthodontic treatment were used in this study. Thirteen landmarks (S, N, Or, A-point, U1T, U1A, B-point, Gn, Pog, Me, Go, L1T, and L1A) were identified on the digital image by an automatic cephalometric software and on cephalometric tracing by manual method. Superimposition of printed image and manual tracing was done by registration at the soft tissue profiles. The accuracy of landmarks located by the automatic method was compared with that of the manually identified landmarks by measuring the mean differences of distances of each landmark on the Cartesian plane where X and Y coordination axes passed through the center of ear rod. One-Sample T test was used to evaluate the mean differences. Statistically significant mean differences (p<0.05) were found in 5 landmarks (Or, A-point, Me, L1T, and L1A) in horizontal direction and 7 landmarks (Or, A-point, U1T, U1A, B-point, Me, and L1A) in vertical direction. Four landmarks (Or, A-point, Me, and L1A) showed significant (p<0.05) mean differences in both horizontal and vertical directions. Small mean differences (<0.5mm) were found for S, N, B-point, Gn, and Pog in horizontal direction and N, Gn, Me, and L1T in vertical direction. Large mean differences were found for A-point (3.0 < 3.5mm) in horizontal direction and L1A (>4mm) in vertical direction. Only 5 of 13 landmarks (38.46%; S, N, Gn, Pog, and Go) showed no significant mean difference between the automatic and manual landmarking methods. It is concluded that if this automatic cephalometric analysis software is used for orthodontic diagnosis, the orthodontist must correct or modify the position of landmarks in order to increase the accuracy of cephalometric analysis.