From: Validity of 2D lateral cephalometry in orthodontics: a systematic review
Authors (year) | Aim of the study | Observers | Subjects | Design of the study | Statistical method | Results according to authors | Level of evidence |
---|---|---|---|---|---|---|---|
Baumrind and Frantz [21] | Quantification of errors in landmark identification | 5 observers | 20 lateral skull radiographs | Observer identified 16 cephalometric landmarks on a transparent plastic template | Mean, standard deviation and standard errors | Least reliable landmarks: gonion and lower incisor apex | Moderate |
Effects of errors on angular and linear measurements | |||||||
Kvam and Krogstad [27] | Evaluation of measurements in lateral cephalograms. | 18 observers | 3 lateral skull radiographs | Hand cephalometric analysis made by each participant, 8 angles measured | Mean and standard deviation | 16 out of 24 angular measurements: less variability in post-graduates than students | Low |
Assess influence of knowledge and impact of angular errors | In 7 measurements, no difference was observed | ||||||
Post-graduates' tracings used for diagnostic purposes | |||||||
Standard deviation of students greater than post-graduates | |||||||
Haynes and Chau [22] | Evaluation of landmark identification on Delaire analysis | 2 observers | 28 lateral skull radiographs | Establish a co-ordinate system for measurement on tracings | Mean deviation | Intra-observer: NS differences between values of T1 and T2 tracings | Moderate |
Comparison with data of conventional cephalometry | Radiographs were traced twice by each observer (3 to 4 weeks) | Inter-observer: differences between the averaged mean values on tracings were NS for either x or y co-ordinates | |||||
Ahlqvist et al. [26] | Study the magnitude of projection errors on measurements in cephalometry | 1 observer | A patient was modelled | Computer software designed to allow movement of model on the 3 axes. The magnitude of errors was studied by a diagram | Measurement errors studied by a diagram with the relative length of distances between modelled landmarks | Less than 1% error on length measurements if head is rotated up to 5° | Low |
Study the effects of incorrect patient position on linear measurements | Head rotated more than 5° the error is increased | ||||||
Houston et al. [23] | Evaluate errors at various stages of measurements in cephalometric radiograph | 4 observers | 24 lateral cephalograms | 2 radiographs of the same patient | Analysis of variance | Error variance is small (radiograph and tracing) when compared with the variance among groups | Moderate |
Radiographs traced on acetate sheet by each observer at T1/T2 (1-week interval) | SNA has a higher tracing variance than SNB due to the difficulty to identify point A | ||||||
Kamoen et al. [24] | Determine errors involved in landmark identification and its consequence to treatment results | 4 observers | 50 lateral cephalograms | Items studied: (1) accuracy of digitiser, (2) intra- and inter-observer digitising errors and (3) intra- and inter-observer tracing errors | (1) Levene's test for homogeneity of variances, (2) one-way ANOVA and (3) Levene's test for homogeneity | (1) NS variances of co-ordinates for landmark at different positions on the digitiser. (2) NS intra- and inter-observer differences in digitisation. (3) S differences in landmarks and in the same landmark on different cephalograms and between observers | Moderate |
Tng et al. [25] | Evaluate the validity of dental and skeletal landmarks. Effect on angles and distances. | 1 observer | 2 lateral cephalograms of 30 dry skulls | Steel balls placed in 15 dental and skeletal landmarks | Mean and standard deviation | 7 out of 10 skeletal and 5 dental landmarks were NS (p < 0.05) | Moderate |
Two radiographs taken with and without the markers and digitised. Measurements compared | 4 angles (SNA-SN/MnP, MxP/MnP and LI/MnP) and 3 distances (N-Me, MxP-Me and Lie to APg) were invalid (p < 0.05) | ||||||
Major errors in angles with dental landmarks | |||||||
Bourriau et al. [5] | Analyse the influence of film-object distance and type of receptor on landmark identification | 53 orthodontists | 4 lateral cephalograms of the same patient | 19 cephalometric landmarks on each film | Mean | NS difference between 2 imaging receptors neither between 2 cephalograms achieved by 2 equipments (p > 0.99) | Low |
2 radiographs performed at an equipment with a 4-m arm and 2 in a 1.50-m arm equipment with 2 different imaging receptors (digital and indirect digital) | Results obtained by cephalometric analysis was judged: ‘very important’ for 20.5%, ‘important’ for 70%, ‘less important’ for 8% and ‘accessory’ for 1 participant |