Clinical applicability of automated cephalometric landmark identification. Part I – Patient-related identification errors.

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Abstract

To determine whether AI systems that recognize cephalometric landmarks can apply to various patient groups and to examine the patient-related factors associated with identification errors.
The present retrospective cohort study analyzed digital lateral cephalograms obtained from 1,785 Japanese orthodontic patients. Patients were categorized into eight subgroups according to dental age, cleft lip and/or palate, orthodontic appliance use, and overjet.
An AI system that automatically recognizes anatomic landmarks on lateral cephalograms was used. Thirty cephalograms in each subgroup were randomly selected and used to test the system’s performance. The remaining cephalograms were used for system learning. The success rates in landmark recognition were evaluated using confidence ellipses with α = 0.99 for each landmark. The selection of test samples, learning of the system, and evaluation of the system were repeated five times for each subgroup. The mean success rate and identification error were calculated. Factors associated with identification errors were examined using a multiple linear regression model.
The success rate and error varied among subgroups, ranging from 85% to 91% and 1.32 mm to 1.50 mm, respectively. Cleft lip and/or palate was found to be a factor associated with greater identification errors, whereas dental age, orthodontic appliances, and overjet were not significant factors (all, p < 0.05).
AI systems that recognize cephalometric landmarks could be applied to various patient groups. Patient-oriented errors were found in patients with cleft lip and/or palate.
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