title: Accuracy and reliability of orthodontists using cone-beam computerized tomography for assessment of adenoid hypertrophy.
abstract: BACKGROUND
  Our objectives were to evaluate the reliability of agreement between orthodontists, with various degrees of cone-beam computed tomography (CBCT) imaging manipulation comfort, in classifying adenoid hypertrophy through CBCT generated images and also to determine how accurate orthodontists are compared with the gold standard diagnosis, nasopharyngoscopy.
  
  
  METHODS
  This was a cross-sectional study in which a randomized list of board-certified orthodontists evaluated different degrees of adenoid hypertrophy of a stratified sampling of 10 scans. The available pool of CBCT images was from a multidisciplinary airway clinic in which children and adolescents had a CBCT scan and a nasopharyngoscopy (reference standard) by an otolaryngologist (head and neck surgeon) on the same day. The participating orthodontists used the same viewer software and computer, and had access to a previously published visual guideline for evaluating adenoid size.
  
  
  RESULTS
  Fourteen orthodontists evaluated 10 CBCT reconstructions. Interoperator reliability was excellent (intraclass correlation coefficient [ICC], 0.941; 95% confidence interval, 0.882-0.984). However, the orthodontists' evaluations against the reference standard demonstrated poor accuracy, (ICC mean, 0.39; ICC range, 0.0-0.74). Dichotomous data representing healthy and unhealthy patients were analyzed individually, and the orthodontists' evaluations and the nasopharyngoscopy results (accuracy) showed, on average, poor kappa values (mean, 0.44; range, 0.20-0.80).
  
  
  CONCLUSIONS
  Different levels of CBCT expertise impacted the assessment accuracy. The participating orthodontists showed excellent consistency among themselves; however, poor agreement between their CBCT assessments compared with nasopharyngoscopy demonstrated that this sample of clinical orthodontists had poor diagnostic accuracy. Together, these findings suggest that orthodontists may make consistent and systematic errors in this type of evaluations.
authors.affiliation: Assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: cppereir@ualberta.ca.
authors.forename: Camila
authors.initials: C
authors.lastname: Pachêco-Pereira
authors.affiliation: Assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Assistant professor, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Noura A
authors.initials: NA
authors.lastname: Alsufyani
authors.affiliation: Director of the Inter-disciplinary Airway Research Clinic and assistant clinical professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Major
authors.affiliation: Associate professor in statistics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Giseon
authors.initials: G
authors.lastname: Heo
authors.affiliation: Professor and Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D002648:Child; D054893:Cone-Beam Computed Tomography; D003430:Cross-Sectional Studies; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging; D015588:Observer Variation; D000066792:Orthodontists / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity