A new method for improved standardisation in three-dimensional computed tomography cephalometry

Interest for three-dimensional computed tomography cephalometry has risen over the last two decades. Current methods commonly rely on the examiner to manually point-pick the landmarks and/or orientate the skull. In this study, a new approach is presented, in which landmarks are calculated after selection of the landmark region on a triangular model and in which the skull is automatically orientated in a standardised way. Two examiners each performed five analyses on three skull models. Landmark reproducibility was tested by calculating the standard deviation for each observer and the difference between the mean values of both observers. The variation can be limited to 0.1 mm for most landmarks. However, some landmarks perform less well and require further investigation. With the proposed reference system, a symmetrical orientation of the skulls is obtained. The presented methods contribute to standardisation in cephalometry and could therefore allow improved comparison of patient data.