Web-based Fully Automated Cephalometric Analysis: Comparisons between App-aided, Computerized, and Manual Tracings

To compare the accuracy of cephalometric analyses made with fully automated tracings, computerized tracing, and app-aided tracings with equivalent hand-traced measurements, and to evaluate the tracing time for each cephalometric analysis method. Methods: Pre-treatment lateral cephalometric radiographs of 40 patients were randomly selected. Eight angular and 4 linear param-eters were measured by 1 operator using 3 methods: computerized tracing with software Dolphin Imaging 13.01(Dolphin Imaging and Management Solutions, Chatsworth, Calif, USA), app-aided tracing using the CephNinja 3.51 app (Cyncronus LLC, WA, USA) , and web-based fully automated tracing with CephX (ORCA Dental AI, Las Vegas, NV). Correction of CephX landmarks was also made. Man-ual tracings were performed by 3 operators. Remeasurement of 15 radiographs was carried out to determine the intra-examiner and inter-examiner (manual tracings) correlation coefficient (ICC). Inter-group comparisons were made with one-way analysis of variance. The Tukey test was used for post hoc testing.Results: Overall, greater variability was found with CephX compared with the other methods. Differences in GoGn-SN (°), I-NA (°), I-NB (°), I-NA (mm), and I-NB (mm) were statistically (p<0.05) and clinically significant using CephX, whereas CephNinja and Dolphin were comparable to manual tracings. Correction of CephX landmarks gave similar results to CephNinja and Dolphin. All the ICCs exceeded 0.85, except for I-NA (°), I-NB (°), and I-NB (mm), which were traced with CephX. The shortest analyzing time was obtained with CephX.Conclusion: Fully automatic analysis with CephX needs to be more reliable. However, CephX analysis with manual correction is prom-ising for use in clinical practice because it is comparable to CephNinja and Dolphin, and the analyzing time is significantly shorter.