Background
Accurate identification of cephalometric landmarks is essential for orthodontic diagnosis and treatment planning. Manual landmarking by orthodontic clinicians can be time-consuming and variable, particularly due to differences in experience. To address this, artificial intelligence (AI) algorithms have been developed to automate cephalometric analysis, aiming to improve efficiency, accuracy, and consistency.
Objectives
This study aimed to evaluate the accuracy of selected skeletal and dental cephalometric landmarks and the resulting linear and angular measurements identified by commercial AI-based providers, compared to those obtained manually by orthodontic clinicians with varying experience against a reference standard.
Methods
Thirty-five lateral cephalometric radiographs from the IEEE ISBI Grand Challenge 2015 dataset were analysed. Ten landmarks were identified on each radiograph by nine calibrated orthodontic clinicians and four commercial AI providers. These were used to calculate nine cephalometric measurements, compared to a reference standard. Agreement among the clinicians was evaluated using the intraclass correlation coefficient (ICC). Friedman’s test, Wilcoxon signed ranks test with Bonferroni correction, and Bland-Altman plots with linear regression were used to test for differences between groups.
Results
ICC values showed six of nine measurements from human clinicians had excellent inter-rater reliability. However, Friedman’s test indicated significant differences between the human clinicians and AI providers against the reference standard for all measurements. Post hoc analysis confirmed these findings. Bland-Altman plots also showed reduced accuracy and consistency across groups.
Conclusions
Both AI algorithms and manual methods showed limited agreement with the reference standard. Further research is needed to improve the accuracy, reliability, and clinical use of AI in cephalometric analysis.
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