Human examination and artificial intelligence in cephalometric landmark detection-is AI ready to take over?

To compare the precision of two cephalometric landmark identification methods, namely a computer-assisted human examination software and an artificial intelligence program, based on South African data.

This retrospective quantitative cross-sectional analytical study utilized a data set consisting of 409 cephalograms obtained from a South African population. 19 landmarks were identified in each of the 409 cephalograms by the primary researcher using the two programs [(409 cephalograms x 19 landmarks) x 2 methods = 15,542 landmarks)]. Each landmark generated two coordinate values (x, y), making a total of 31,084 landmarks. Euclidean distances between corresponding pairs of observations was calculated. Precision was determined by using the standard deviation and standard error of the mean.

The primary researcher acted as the gold-standard and was calibrated prior to data collection. The inter- and intrareliability tests yielded acceptable results. Variations were present in several landmarks between the two approaches; however, they were statistically insignificant. The computer-assisted examination software was very sensitive to several variables. Several incidental findings were also discovered. Attempts were made to draw valid comparisons and conclusions.

There was no significant difference between the two programs regarding the precision of landmark detection. The present study provides a basis to: (1) support the use of automatic landmark detection to be within the range of computer-assisted examination software and (2) determine the learning data required to develop AI systems within an African context.