Reproducibility of measurements in tablet-assisted, PC-aided, and manual cephalometric analysis

To assess the reproducibility of cephalometric measurements performed with software for a tablet, with a program for personal computers (PCs), and manually.

The pretreatment lateral cephalograms of 20 patients that were acquired using the same digital cephalometer were collected. Tracings were performed with NemoCeph for Windows (Nemotec), with SmileCeph for iPad (Glace Software), and by hand. Landmark identification was carried out with a mouse-driven cursor using NemoCeph and with a stylus pen on the iPad screen using SmileCeph. Hand tracings were performed on printouts of the cephalograms, using a 0.3-mm 2H pencil and a protractor. Cephalometric landmarks and linear and angular measurements were recorded. All the tracings were done by the same investigator. To evaluate reproducibility, for each cephalometric measurement the agreement between the value derived from NemoCeph, that given by SmileCeph and that measured manually was assessed with the intraclass correlation coefficient (ICC). Agreement was rated as low for an ICC≤0.75, and an ICC>0.75 was considered indicative of good agreement. Also, differences in measurements between each software and manual tracing were statistically evaluated (P<.05).

All the measurements had ICC>0.8, indicative of a high agreement among the tracing methods. Relatively lower ICCs occurred for linear measurements related to the occlusal plane and to N perpendicular to the Frankfurt plane. Differences in measurements between both software programs and hand tracing were not statistically significant for any of the cephalometric parameters.

Tablet-assisted, PC-aided, and manual cephalometric tracings showed good agreement.