Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors
Abstract Background Cephalometric radiography has been used for orthodontic and surgical treatment planning and assessment, and for quantifying mandibular growth. However, it remains unclear how head positioning errors and the level of examiner experience affect the reliability of such morphometric...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-05-01
|
| Series: | BioMedical Engineering OnLine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12938-017-0353-8 |
| _version_ | 1818218483663503360 |
|---|---|
| author | Hsien-Shu Lin Yunn-Jy Chen Hsuan-Lun Lu Tung-Wu Lu Chien-Chih Chen |
| author_facet | Hsien-Shu Lin Yunn-Jy Chen Hsuan-Lun Lu Tung-Wu Lu Chien-Chih Chen |
| author_sort | Hsien-Shu Lin |
| collection | DOAJ |
| description | Abstract Background Cephalometric radiography has been used for orthodontic and surgical treatment planning and assessment, and for quantifying mandibular growth. However, it remains unclear how head positioning errors and the level of examiner experience affect the reliability of such morphometric measurements. The current study aimed to bridge the gap by determining the intra-, inter-rater, and inter-session reliability of measurements of mandibular morphology with random head positioning errors as measured by a junior and a senior dentist. Methods Cone-beam computed tomography data of twelve mandibles were obtained with each rotated randomly away from the neutral position within the range of +3 and −3° along each of the anatomical axes to simulate six imaging trials. A synthetic cephalogram for each trial was obtained via a digitally reconstructed radiography (DRR) technique and eleven landmarks for twelve morphological parameters on the cephalogram were identified manually six times by a junior and a senior dentist. The procedure was repeated on another day within 5 days. Test–retest reliability was assessed in terms of an intra-class correlation coefficient (ICC) using a two-way mixed-effects model. Results Good to very good intra-rater (senior: ICC > 0.92; junior: ICC > 0.78), inter-rater (ICC > 0.70 for most parameters) and inter-session reliability (senior: ICC > 0.84; junior: ICC > 0.62) were found. Bland & Altman plots of inter-rater comparisons show that there were systematical biases between the examiners on most parameters, except for the distance between Gonion and Pogonion. Conclusions The current results suggest that good to very good intra-rater, inter-rater and inter-session reliability can be achieved for most parameters with randomized head positioning errors; higher inter-session reliability can be achieved by more experienced examiners; and that long-term monitoring of mandibular growth based on cephalographic measurements should be made by the same more experienced examiner. The current DRR-based approach can be used to evaluate individual factors that affect the morphological measurements. |
| first_indexed | 2024-12-12T07:24:29Z |
| format | Article |
| id | doaj.art-19b3416af9314f5685dfd68d85daf787 |
| institution | Directory Open Access Journal |
| issn | 1475-925X |
| language | English |
| last_indexed | 2024-12-12T07:24:29Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BioMedical Engineering OnLine |
| spelling | doaj.art-19b3416af9314f5685dfd68d85daf7872022-12-22T00:33:12ZengBMCBioMedical Engineering OnLine1475-925X2017-05-0116111410.1186/s12938-017-0353-8Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errorsHsien-Shu Lin0Yunn-Jy Chen1Hsuan-Lun Lu2Tung-Wu Lu3Chien-Chih Chen4Department of Dentistry, School of Dentistry, National Taiwan University HospitalDepartment of Dentistry, School of Dentistry, National Taiwan University HospitalInstitute of Biomedical Engineering, National Taiwan UniversityInstitute of Biomedical Engineering, National Taiwan UniversityDepartment of Dentistry, School of Dentistry, National Taiwan University HospitalAbstract Background Cephalometric radiography has been used for orthodontic and surgical treatment planning and assessment, and for quantifying mandibular growth. However, it remains unclear how head positioning errors and the level of examiner experience affect the reliability of such morphometric measurements. The current study aimed to bridge the gap by determining the intra-, inter-rater, and inter-session reliability of measurements of mandibular morphology with random head positioning errors as measured by a junior and a senior dentist. Methods Cone-beam computed tomography data of twelve mandibles were obtained with each rotated randomly away from the neutral position within the range of +3 and −3° along each of the anatomical axes to simulate six imaging trials. A synthetic cephalogram for each trial was obtained via a digitally reconstructed radiography (DRR) technique and eleven landmarks for twelve morphological parameters on the cephalogram were identified manually six times by a junior and a senior dentist. The procedure was repeated on another day within 5 days. Test–retest reliability was assessed in terms of an intra-class correlation coefficient (ICC) using a two-way mixed-effects model. Results Good to very good intra-rater (senior: ICC > 0.92; junior: ICC > 0.78), inter-rater (ICC > 0.70 for most parameters) and inter-session reliability (senior: ICC > 0.84; junior: ICC > 0.62) were found. Bland & Altman plots of inter-rater comparisons show that there were systematical biases between the examiners on most parameters, except for the distance between Gonion and Pogonion. Conclusions The current results suggest that good to very good intra-rater, inter-rater and inter-session reliability can be achieved for most parameters with randomized head positioning errors; higher inter-session reliability can be achieved by more experienced examiners; and that long-term monitoring of mandibular growth based on cephalographic measurements should be made by the same more experienced examiner. The current DRR-based approach can be used to evaluate individual factors that affect the morphological measurements.http://link.springer.com/article/10.1186/s12938-017-0353-8Intra-class correlation coefficient (ICC)MandibleReliabilitySimulated radiographHead positioning |
| spellingShingle | Hsien-Shu Lin Yunn-Jy Chen Hsuan-Lun Lu Tung-Wu Lu Chien-Chih Chen Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors BioMedical Engineering OnLine Intra-class correlation coefficient (ICC) Mandible Reliability Simulated radiograph Head positioning |
| title | Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors |
| title_full | Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors |
| title_fullStr | Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors |
| title_full_unstemmed | Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors |
| title_short | Test–retest reliability of mandibular morphology measurements on cone-beam computed tomography-synthesized cephalograms with random head positioning errors |
| title_sort | test retest reliability of mandibular morphology measurements on cone beam computed tomography synthesized cephalograms with random head positioning errors |
| topic | Intra-class correlation coefficient (ICC) Mandible Reliability Simulated radiograph Head positioning |
| url | http://link.springer.com/article/10.1186/s12938-017-0353-8 |
| work_keys_str_mv | AT hsienshulin testretestreliabilityofmandibularmorphologymeasurementsonconebeamcomputedtomographysynthesizedcephalogramswithrandomheadpositioningerrors AT yunnjychen testretestreliabilityofmandibularmorphologymeasurementsonconebeamcomputedtomographysynthesizedcephalogramswithrandomheadpositioningerrors AT hsuanlunlu testretestreliabilityofmandibularmorphologymeasurementsonconebeamcomputedtomographysynthesizedcephalogramswithrandomheadpositioningerrors AT tungwulu testretestreliabilityofmandibularmorphologymeasurementsonconebeamcomputedtomographysynthesizedcephalogramswithrandomheadpositioningerrors AT chienchihchen testretestreliabilityofmandibularmorphologymeasurementsonconebeamcomputedtomographysynthesizedcephalogramswithrandomheadpositioningerrors |