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Updated: Jul 2, 2026
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Three-Dimensional Cephalometric Landmark Annotation Demonstration on Human Cone Beam Computed Tomography Scans
Published on: September 8, 2023
Observer reliability of three-dimensional cephalometric landmark identification on cone-beam computerized tomography
Ana Emilia F de Oliveira1, Lucia Helena S Cevidanes, Ceib Phillips
1Department of Dentistry-I, Universidade Federal do Maranhão, Maranhão, Brazil.
Summary
Cone-beam computed tomography (CBCT) offers excellent reliability for 3D landmark identification in orthognathic surgery. Consistent results are achievable with standardized operator training and calibration protocols.
Area of Science:
- Dentistry
- Radiology
- Medical Imaging
Background:
- Accurate 3D landmark identification is crucial for orthognathic surgery planning.
- Cone-beam computed tomography (CBCT) is increasingly used for surgical planning.
Purpose of the Study:
- To assess the reliability of 3D landmark identification using CBCT.
- To evaluate both intraobserver and interobserver variability in landmark identification.
Main Methods:
- Selected 12 CBCT scans from 159 orthognathic surgery patients.
- Three observers independently identified 30 landmarks three times on sagittal, coronal, and axial slices.
- Intraclass correlation coefficients (ICC) and systematic bias were analyzed using a mixed-effects ANOVA model.
Main Results:
- Excellent intraobserver reliability (ICC >0.9) was observed in 86% of assessments.
- Good interobserver reliability (ICC >0.9) was found in 66% of assessments.
- Minimal systematic differences were noted across observers, particularly in the Y dimension.
Conclusions:
- 3D landmark identification using CBCT demonstrates excellent intra- and interobserver reliability.
- Standardized protocols for operator training and calibration are essential for consistent and reproducible CBCT data.
- Reliability is particularly important for landmarks that are challenging to define across all three spatial planes.
