Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 10 Apr 2025

Accuracy and reliability of automated landmark identification and cephalometric measurements on cone beam computed tomography using Invivo software

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DOI: 10.2319/122324-1049.1
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ABSTRACT

Objectives

To evaluate the accuracy and reliability of an automated landmark identification (ALI) system and the impact of ALI errors on cephalometric measurements on cone-beam computed tomography (CBCT) images.

Materials and Methods

Thirty-one landmarks were identified on 76 CBCT images using Invivo7 software (Anatomage, San Jose, Calif). Ground truth was established by averaging landmark coordinates from two calibrated human examiners. The accuracy of the ALI system was assessed by the mean absolute error (MAE, mm) across coordinate axes, the mean error distance (mm), and the successful detection rate (SDR) for each landmark. Interexaminer reliability between the ALI and manual landmark location was evaluated. Eighteen cephalometric measurements were computed from 25 landmarks. Accuracy of measurements from the ALI system was assessed with the MAE and successful measurement rates (SMR).

Results

The ALI system closely matched human examiners in landmark identification, with an average MAE of 0.94 ± 0.99 mm. Across all three coordinate axes, 87% of the landmarks had <2 mm MAE. ALI average MAE for conventional linear and angular cephalometric measurements were 1.35 ± 1.33 mm and 0.89 ± 0.89 degrees, respectively. Only one measurement, Intercondylar Width, showed MAE >3 mm.

Conclusions

The ALI system showed clinically acceptable accuracy and reliability for the majority of cephalometric landmarks and measurements. Clinicians are advised to critically evaluate ALI landmarks with substantial errors, to fully utilize the capabilities of commercial software effectively.

Copyright: © 0000 by The EH Angle Education and Research Foundation, Inc.

Contributor Notes

 Clinical Assistant Professor, Department of Orthodontics, New York University, College of Dentistry, New York, NY, USA.
 Assistant Professor, Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA.
 Associate Professor, Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA.
 Professor and Chair, Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA.
Corresponding author: Dr Heeyeon Suh, Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California 94103, USA (e-mail: hsuh1@pacific.edu)
Received: 23 Dec 2024
Accepted: 10 Mar 2025
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