title: The Effect of Emboss Enhancement on Reliability of Landmark Identification in Digital Lateral Cephalometric Images.
abstract: BACKGROUND
  Evaluation of the craniofacial bones is the oldest method to measure the facial proportion ratio in orthodontics.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the effect of emboss enhancement on the reliability of landmark identification in digital lateral cephalometric images.
  
  
  METHODS
  Ten digital lateral cephalograms were selected from the archive of an oral and maxillofacial radiology center. Using DIGORA software, these images were saved in two formats; common images and 3D emboss images. On these images, 32 skeletal, dental, and soft tissue landmarks were marked at least twice with a 2-week interval by four observers (two radiologists and two orthodontists). In order to determine the position of the marked landmarks (in x and y coordinates), a software was designed. The statistical analysis was performed in SPSS software and the reliability of each observer was obtained by means of intraclass correlation coefficient (ICC).
  
  
  RESULTS
  In three skeletal landmarks [Orbit (Or), condyl top (Cond), and pogonion (Pog)], the enhancement caused significant reduction in the reliability, and in four skeletal [Anterior Nasal Spine (ANS), B, A, and Basion (Ba)], two dental (U1 root, L1 incisal), and one soft tissue landmark (Menton soft tissue), the enhancement increased the reliability of landmark detection between the two phases of the study. Totally, ICC of embossed images in both x and y coordinates were greater than the typical images, but the difference was not statistically significant. However, the effect of enhancement on the improvement of the reliability of landmark identification was higher in the x-axis than the y-axis.
  
  
  CONCLUSIONS
  Using embossed images is only effective in increasing the reliability of detection in a few numbers of cephalometric landmarks.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Sima
authors.initials: S
authors.lastname: Nikneshan
authors.affiliation: Department of Oral and Maxillofacial Radiology, Dental Faculty, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Sudeh
authors.initials: S
authors.lastname: Mohseni
authors.affiliation: Department of Orthodontics, Dental Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Nouri
authors.affiliation: Department of Oral and Maxillofacial Radiology, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hoora
authors.initials: H
authors.lastname: Hadian
authors.affiliation: Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Javad
authors.initials: MJ
authors.lastname: Kharazifard
keywords: Cephalometry; Emboss Enhancement; Reliability