title: Precision of cephalometric landmark identification: cone-beam computed tomography vs conventional cephalometric views.
abstract: BACKGROUND
  In this study, we compared the precision of landmark identification using displays of multi-planar cone-beam computed tomographic (CBCT) volumes and conventional lateral cephalograms (Ceph).
  
  
  METHODS
  Twenty presurgical orthodontic patients were radiographed with conventional Ceph and CBCT techniques. Five observers plotted 24 landmarks using computer displays of multi-planer reconstruction (MPR) CBCT and Ceph views during separate sessions. Absolute differences between each observer's plot and the mean of all observers were averaged as 1 measure of variability (ODM). The absolute difference of each observer from any other observer was averaged as a second measure of variability (DEO). ANOVA and paired t tests were used to analyze variability differences.
  
  
  RESULTS
  Radiographic modality and landmark were significant at P <0.0001 for DEO and ODM calculations. DEO calculations of observer variability were consistently greater than ODM. The overall correlation of 1920 paired ODM and DEO measurements was excellent at 0.972. All bilateral landmarks had increased precision when identified in the MPR views. Mediolateral variability was statistically greater than anteroposterior or caudal-cranial variability for 5 landmarks in the MPR views.
  
  
  CONCLUSIONS
  The MPR displays of CBCT volume images provide generally more precise identification of traditional cephalometric landmarks. More precise location of condylion, gonion, and orbitale overcomes the problem of superimposition of these bilateral landmarks seen in Ceph. Greater variability of certain landmarks in the mediolateral direction is probably related to inadequate definition of the landmarks in the third dimension.
authors.affiliation: Department of Diagnostic Sciences and General Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA. jbl@email.unc.edu
authors.forename: John B
authors.initials: JB
authors.lastname: Ludlow
authors.forename: Maritzabel
authors.initials: M
authors.lastname: Gubler
authors.forename: Lucia
authors.initials: L
authors.lastname: Cevidanes
authors.forename: André
authors.initials: A
authors.lastname: Mol
mesh_terms: D002508:Cephalometry / Q000379:methods / Q000706:statistics & numerical data*; D002680:Chin / Q000000981:diagnostic imaging; D003196:Computer Graphics / Q000706:statistics & numerical data; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D004424:Ear Canal / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008046:Lip / Q000000981:diagnostic imaging; D008334:Mandible / Q000000981:diagnostic imaging; D008335:Mandibular Condyle / Q000000981:diagnostic imaging; D008437:Maxilla / Q000000981:diagnostic imaging; D009295:Nasal Bone / Q000000981:diagnostic imaging; D009666:Nose / Q000000981:diagnostic imaging; D015588:Observer Variation; D009915:Orbit / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012658:Sella Turcica / Q000000981:diagnostic imaging