Accuracy and reliability of Keynote for tracing and analyzing cephalometric radiographs

To evaluate the reliability and accuracy of Keynote for tracing and analyzing cephalograms in comparison to Quick Ceph Studio.

This was a cross-sectional study, which utilized the lateral cephalometric digital images (radiographs) from 49 patients. The study site was the Dental Radiology unit in the School of Dentistry of the Muhimbili University of Health and Allied Sciences (MUHAS), in Dar es Salaam, Tanzania. Cephalograms were imported to Quick Ceph Studio and then to Keynote for analysis. Minimum, maximum, mean, standard deviation, and mean difference were used to describe the data. Agreement between the two techniques was assessed by the Bland-Altman plot, linear regression, and interexaminer reliability tests. A level of significance was considered at P < .05, and a 95% CI was estimated for the outcomes in the study groups.

The majority of the mean values obtained from Quick Ceph were greater (P < .05) than those obtained from Keynote. According to Bland-Altman plots, all measurements were within the limit of agreement except for only five linear variables. The interexaminer reliability test showed no agreement between the two instruments for all linear parameters except for the LAFH: TAFH, whereas all angular measurements revealed good to excellent agreement (ICC: 0.75 to 0.97) between the methods.

The measurements obtained with the Keynote software were found to be clinically reliable since the limits did not exceed the maximum acceptable difference between the methods. The two software instruments were considered to be in agreement and can be used interchangeably.