Phosphor-stimulated computed cephalometry: reliability of landmark identification

The aim of this randomized, controlled, prospective study was to determine the reliability of computed lateral cephalometry (Fuji Medical Systems, Tokyo, Japan) in terms of landmark identification compared to conventional lateral cephalometry (CAWO, Schrobenhausen, Germany). To assess the reliability of landmark identification on lateral cephalographs, 20 computed images, taken at 30 per cent reduced radiation (70 kV, 15 mA, 0.35 s) were compared to 20 conventional images (70 kV, 15 mA, 0.5 s). The 40 lateral cephalographs were taken from 20 orthodontic patients at immediate post-treatment and 1 year after retention. The order and type of imaging was randomized. Five orthodontists identified eight skeletal, four dental and five soft tissue landmarks on each of the 40 films. The error of identification was analysed in the XY Cartesian co-ordinate following digitization. Skeletal landmarks exhibited characteristic dispersion with respect to the Cartesian co-ordinates. Root apices were more variable than crown tips. Soft tissue landmarks were more consistent in the X co-ordinate. Two-way ANOVA shows that there is no significant difference between the two imaging systems in both co-ordinates (P > 0.05). Moreover, the differences are generally small (< 0.5 mm), and are unlikely to be of clinical significance. Most of the variables attained statistical power of at least 0.8 in the X-co-ordinate while only the dental landmarks achieved statistical power of at least 0.78 in the Y-co-ordinate. Based on the results of the study: (1) computed lateral cephalographs can be taken at 30 per cent radiation reduction, compared to conventional lateral cephalograph; (2) each anatomical landmark exhibits its characteristic dispersion of error in both the Cartesian co-ordinates; (3) there is no trend between the two imaging systems, with equivocal result, and none of the landmarks attained statistical significance when both raters and imaging systems are considered as factorial variables; (4) the random error of raters in landmark identification after replicate tracing was highlighted and needs to be taken into consideration in all studies involving landmark identification.