Size of the C7-T1 articular processes is overestimated on lateral radiographs when compared to standing cone beam computed tomography.

Objective To evaluate the intraobserver and intreobserver reliability of the Sub-axial Injury Classification (SLIC) evaluation system for sub-axial cervical spine injury. Methods The preoperative imaging data (posteroanterior and lateral radiographs,CT,MRI) and clinical data which had not been premeasured were evaluated and classified using SLIC system in the 54 patients with sub-axial cervical spine injury who had been treated in our department between May 2008 and April 2010.The same data which had been presented in a different order were evaluated and classified again 4 weeks later in a same manner.The average percentages of intraobserver and interobserver agreements were calculatec.The reliability and reproducibility were quantified using kappa statistics and intraclass correlation coefficients (ICC). Results The SLIC system was found to have intermediate and high interobserver and intraobserver agreements respectively in evaluation of the morphology and neurological function of the injury.The interobserver reliabilities were 62.7％ (Kappa =0.502,ICC =0.581 ) and 69.7％ ( Kappa =0.616,ICC =0.867 ) respectively while the intraobserver reliabilities were71.8％ (Kappa =0.631,ICC =0.746) and 79.6％ (Kappa =0.735,ICC =0.871) respectively.The SLIC system had poor interobserver and intraobserver agreement in evaluation of diseo-ligamentous complex (DLC) injury.The interobserver reliability was 55,8％ ( Kappa =0.317,ICC =0.483 ) and the intraobserver reliability was 68.9％ ( Kappa =0.517,ICC =0.643).The global SLIC evaluation obtained an interobserver reliability of 30.7％ (Kappa=0.218,ICC=0.725) and an intraobserver reliability of 44.5％ (Kappa=0.394,ICC=0.812).For therapy selection,the interobserver reliability was 72.4％ ( Kappa =0.431,ICC =0.578 ) and the intraobserver reliability was 78.8％ ( Kappa =0.581,ICC =0.759). Conclusions The SLIC system has excellent interobserver and intraobserver agreements in evaluation of morphology and neurological function of the injury and in therapy selection as well.This system is not so good for evaluation of DLC injury because MRI imaging cannot make a definite judgment on ligament injury. Key words: Cervical spine; Wounds and injuries; Reliability and validity

To compare palatal bone height measurements in the region of first premolars for planning palatal mini-implant insertion on conventional lateral radiography (CLR), cone beam computed tomography (CBCT), and reformatted virtual lateral radiography (VLR). One hundred ten images of CLR, VLR, and CBCT from the same patient were used. Linear measurements corresponding to the relevant dimension of available bone on upper first premolar site were performed between the hard palate floor and the nasal floor. The Friedman test compared the measurements of all imaging modalities. Intraobserver and interobserver agreement was calculated with the intraclass correlation coefficient (ICC). The ICC values showed excellent intraobserver and interobserver agreement. VLR examination resulted in measurements statistically different from both CBCT and CLR images (P < 0.05), being underestimated when compared with these techniques, and the values found on CLR did not show statistically significant differences from the CBCT images (P > 0.05). The measurements for planning palatal mini-implants at the level of first premolars are comparable on CLR and multiplanar reconstructions of CBCT, whereas underestimated in reformatted examinations (VLR).

The primary objectives of this pilot study were to evaluate the radiation dose, breast coverage, and image quality of cone-beam breast CT compared with a conventional mammographic examination. Image quality analysis was focused on the concordance of cone-beam breast CT with conventional mammography in terms of mammographic findings. This prospective study was performed from July 2006 through August 2008. Twenty-three women were enrolled who met the inclusion criteria, which were age 40 years or older with final BI-RADS assessment category 1 or 2 lesions on conventional mammograms within the previous 6 months. The breasts were imaged with a flat-panel detector-based cone-beam CT system, and the images were reviewed with a 3D visualization system. Cone-beam breast CT image data sets and the corresponding mammograms were reviewed by three qualified mammographers. The parameters assessed and compared in this pilot study were radiation dose, breast tissue coverage, and image quality, including detectability of masses and calcifications. The mammograms and cone-beam breast CT images were independently reviewed side by side, and the reviewers were not blinded to the other technique. The observed agreement and Cohen's kappa were used to evaluate agreement between the mammographic and cone-beam breast CT findings and interobserver agreement. Each subject responded to a questionnaire on multiple parameters, including comfort of the cone-beam breast CT examination compared with mammography. For a conventional mammographic examination, the average glandular radiation dose ranged from 2.2 to 15 mGy (mean, 6.5 [SD, 2.9] mGy). For cone-beam breast CT, the average glandular dose ranged from 4 to 12.8 mGy (mean, 8.2 [SD, 1.4] mGy). The average glandular dose from cone-beam breast CT was generally within the range of that from conventional mammography. For heterogeneously dense and extremely dense breasts, the difference between the mean dose of conventional mammography and that of cone-beam breast CT was not statistically significant (7.0 vs 8.1 mGy, p = 0.06). Breast tissue coverage was statistically significantly better with cone-beam breast CT than with mammography in the lateral (p < 0.0001), medial (p < 0.0001), and posterior (p = 0.0002) aspects. Mammography had statistically significantly better coverage than cone-beam breast CT in the axilla and axillary tail (p < 0.0001). Overall, most calcifications and all masses detected with mammography were also detected with cone-beam breast CT. The interobserver agreement on cone-beam breast CT was 83.7% in the detectability of imaging findings. The overall interobserver agreement on type of findings, size of findings (<1, 1-4.99, and > or = 5 mm), and location of findings was 77.2%, 84.8%, and 78.3%, respectively. The results of this study show that cone-beam breast CT can be used to image the entire breast from chest wall to nipple with sufficient spatial and contrast resolution for detection of masses and calcifications at a radiation dose within the range of that of conventional mammography.

The aim of this study was to compare the performance of conebeam computed tomography (CBCT), clinical and surgical probing in assessing maxillary molar furcation involvement (FI). Furcation defects (n= 120) were assessed through CBCT, clinical and intra-surgical evaluation (ISE). Furcation Involvement, vertical and horizontal bone loss were assessed through clinical probing, CBCT and probing during ISE. Three trained radiologists evaluated CBCT images and intra- and interobserver agreement were calculated by Kappa test and Intraclass Correlation Coefficient (ICC). McNemar and Wilcoxon tests were used to compare clinical probing, ISE and CBCT. Accuracy, sensitivity, specificity, positive and negative predictive values were calculated to detect FI. Clinical findings showed 28 sites with Degree I, 25 sites with Degree II, and 8 sites with Degree III. Good intra- (k=1.00) and interobserver agreement (k=0.773) were observed. Intraobserver and interobserver agreement for horizontal bone loss were moderate, k=0.485 and k=0.549, respectively. Intra-surgical findings showed Degree I at 21 sites, and Degree II and Degree III FI at fifteen sites each. Clinical evaluation showed 75% agreement with ISE and 78% with CBCT. Accuracy for clinical detection of FI was 75%, while for CBCT evaluation ranged from 72.5% to 77.5%, considering the 3 observers. Significant differences were found at distal sites using CBCT (p<0.05). Clinical evaluation and CBCT showed similar results for the presence or absence of FI. Concerning horizontal and vertical bone loss, CBCT was not considered a precise examination method for incipient bone defects.

Whole body low dose CT to assess overall burden of osteoarthritis: development of an atlas and reliability testing of a new scoring system

Caudal cervical articular process joint osteoarthritis (CAPJ OA) leads to career-altering clinical signs in the horse. Oblique radiographs and standing cone beam computed tomography (CBCT) facilitate the assessment of this area, however, the variability of interpretation of these images is currently unknown. This retrospective, secondary analysis, methods comparison study investigated interobserver agreement between clinicians and modality in grades of CAPJ OA on lateral and oblique radiographs and CBCT. We hypothesized that agreement between clinicians' grades of CAPJ OA would be lowest for oblique radiographs and highest for CBCT, and agreement between grades of CAPJ OA would be low for all pairs of modalities. Horses underwent lateral and oblique radiography and CBCT of the CAPJs of C5-C6 and C6-C7. Radiographs and CBCT images were graded retrospectively by four blinded clinicians using 3-point scales. Cohen's kappa analysis was used to evaluate interobserver agreement between grades of CAPJ OA, and agreement between grades of CAPJ OA between different modalities was explored using kappa-weighted analysis. Agreement between clinicians' grades of CAPJ OA was moderate for lateral radiographs (0.49), and fair for oblique radiographs (0.23) and CBCT (0.36). For all modalities, agreement was slight to fair between clinicians for CAPJs with grade 1 (normal, 0.21-0.32) or 2 (mild, 0.13-0.36) CAPJ OA, and moderate to substantial for grade 3 (moderate to severe, 0.45-0.77) CAPJ OA. Agreement between grades of CAPJ OA was fair for all pairs of modalities. This study provides important information regarding the inconsistency of interpretation of mild CAPJ OA on radiographs and CBCT amongst clinicians.

To compare different imaging procedures [cone beam computed tomography (CBCT), computed tomography (CT), magnetic resonance imaging (MRI), orthopantomography (OPG), and lateral cephalometry (LC)] for assessing the mandibular height [ramus height (RH)] and condylar process (CondProc) length as they reflect mandibular growth. The RH and CondProc of eight cadaver heads (each side separately) were measured using CBCT, CT, MRI, OPG, and LC. They were measured twice by two independent observers parallel to the posterior border of the mandibular ramus. An intraclass correlation coefficient (ICC) was used to assess the inter- and intraobserver reliability. The coefficient of variation was used to elucidate precision. Bland-Altman (BA) plots were used to assess the agreement between the procedures and the intra- and interobserver measurements. All procedures, with the exception of LC, showed good intra- and interobserver agreement (maximum range of agreement: 5.3mm) and excellent reliability (ICC > 0.9). The BA plot analysis for the CondProc and RH showed similar ranges of agreement between MRI, CT, and CBCT (maximum 6.4mm) but higher ranges for OPG and LC. The MRI and OPG values were generally smaller. All 3D imaging procedures yielded nearly equal results when used to measure the CondProc and RH. MRI is recommended because it avoids ionizing radiation and has higher sensitivity in the detection of inflammation. A 2-year threshold for detecting growth in the follow-up period should be taken into account for all 3D imaging methods. Measuring the RH is recommended for the follow-up of condylar growth because reference values for annual increments are published.

ObjectiveConventional radiography is the first modality to investigate the radio-ulno-carpal joint in the event of trauma or instability. This study sought to determine the reliability of cone beam computer tomography (CBCT) and scout of view in evaluating carpal alignment compared with conventional radiographs in order to assess the influence of wrist kinematics on usual measurements. Materials and methodsWe prospectively recruited 305 patients who successively underwent plain radiography and CBCT. 51 patients with prior acute unilateral wrist trauma were eligible for entry into the study (mean age of 39 years). Three blinded readers performed the measurements separately. The axial method and bony axial lines defined previously in the literature were applied, with three categories of measurements performed, consisting of distal radio-ulnar, radiocarpal, and radio/carpometacarpal measurements. Intraclass correlation coefficients (ICCs) for paired t-test were calculated to assess inter- and intra-observer agreements. ResultsInter-observer agreement was very high (>0.94) for all modalities. Intra-observer reliability between scout view and CBCT was almost perfect for all measurements. Intra-observer reliability between radiograph and scout view/CBCT was perfect for distal radio-ulnar measurements, substantial for radio-carpal, and moderate for radio/carpometacarpal measurements. ConclusionIn the absence of a strict position control between two imaging acquisitions, only distal radio-ulnar measurements were shown perfectly reliable when using these two imaging methods, which is suggestive of a minor relevance of ulnar/radial deviation. Excepting for some angles, the radio-carpal and radio-carpometacarpal measurements were shown to differ according to wrist position, being thus more sensitive to flexion/extension of the wrist.

BackgroundThis study compared the diagnostic accuracy of cone beam computed tomography (CBCT) and intraoral radiographs (IOR) for detecting periodontal defects.Materials and methodsA total of 67 periodontal defects, including 39 dehiscence, 13 fenestration, and 15 Class III furcation defects, were experimentally created were artificially created on eight dry skull mandibles. The images of these defects were taken with IOR and CBCT. The resulting images were evaluated by two observers in a double-blind manner. Kappa statistics, McNemar and McNemar-Browner tests, Chi-square test, and Bonferroni-corrected Z test were used for statistical analysis.ResultsExcellent intra-observer and inter-observer agreement was observed in our study. In detecting periodontal defects (dehiscence, fenestration, and Class III furcation defect), sensitivity, specificity, and accuracy were found to be 96%, 64%, and 72%, respectively, for IOR, and 100%, 96%, and 97%, respectively, for CBCT. While the rate of detecting periodontal defects was 49.5% for IOR, it was 70% for CBCT. Statistically significant difference was found between IOR and CBCT in detecting periodontal defects (p = 0.004). Statistically significant difference was found between IOR and CBCT in detecting dehiscence (p = 0.007). No statistically significant difference was found between IOR and CBCT in detecting fenestration and Class III furcation defects.ConclusionsA statistically significant difference was found between CBCT and IOR in terms of the detection of dehiscence, one of the periodontal defects, and CBCT was concluded to be more successful than IOR in the diagnosis of dehiscence defects. No statistically significant difference was found between IOR and CBCT in detecting fenestration and Class III furcation type defects. CBCT was found to be more successful than IOR in detecting defects in the anterior region. However, no difference was found between the two methods in the posterior region.

Precise reduction of a syndesmosis after disruption is critical to improve patient physical function. Intraoperative lateral radiographs of the unaffected ankle are often used in clinical practice as a template for anatomic syndesmotic reduction because sagittal plane malreduction is common. However, there is little data to suggest fibular station, or the position of the fibula in the AP plane on the lateral radiograph, is symmetric side-to-side in patients. (1) Is the position of the fibula in the AP plane (fibular station) on lateral ankle radiographs symmetric in an individual? (2) Do the measurements used to judge the position of the fibula on lateral radiographs have good inter- and intraobserver reliability? Over the period from August 2016 to October 2018, we identified 478 patients who presented to an orthopaedic clinic with forefoot and midfoot complaints. Skeletally mature patients with acceptable bilateral lateral ankle radiographs, which are common radiographs obtained for new patients to clinic for any complaint, were included. Based on that, 52% (247 of 478 patients) were included with most (22%, 107 patients) excluded for poor lateral radiographs. The most common diagnosis in the patient cohort was midfoot OA (14%, 35 patients). The median (range) age of the included patients was 54 years (15 to 88), and 65% (159 of 247) of the patients were female. Fibular station, defined as the position of the fibula in the AP plane, and fibular length were measured using a digital ruler and goniometer on lateral radiographs. A paired t-test was used to determine if no difference in fibular station existed between the left and right ankles. With 247 paired-samples, with 80% power and an alpha level of 0.05, we could detect a difference between sides of 0.008 for the posterior ratio, 0.010 for the anterior ratio, and 0.012 for fibular length. Two readers, one fellowship-trained orthopaedic traumatologist and one PGY-4, measured 40 patients to determine the inter- and intraobserver reliability by intraclass correlation coefficient (ICC). The posterior fibular station (mean right 0.147 [σ = 0.056], left 0.145 [σ = 0.054], difference = 0.03 [95% CI 0 to 0.06]; p = 0.59), anterior fibular station (right 0.294 [σ = 0.062], left 0.299 [σ = 0.061], difference = 0.04 [95% CI 0 to 0.08]; p = 0.20), and fibular length (right 0.521 [σ = 0.080], left 0.522 [σ = 0.078], difference = 0.05 [95% CI 0.01 to 0.09]; p = 0.87) ratios did not differ with the numbers available between ankles. Inter- and intraobserver reliability were excellent for the posterior ratio (ICC = 0.928 and ICC = 0.985, respectively) and the anterior ratio (ICC = 0.922 and ICC = 0.929, respectively) and moderate-to-good for the fibular length ratio (ICC = 0.732 and ICC = 0.887, respectively). The use of lateral radiographs of the contralateral uninjured ankle appears to be a valid template for determining the position of the fibula in the sagittal plane. However, further prospective studies are required to determine the efficacy of this method in reducing the syndesmosis over other methods that exists. Level III, diagnostic study.

To evaluate the accuracy of available bone width, height, and length measurements on pre-planned implant sites using CBCT images scanned at different angulations of the mandible. Standard cylindrical holes were prepared on six dry human mandibles and filled with warm gutta-percha to create spherical markers for measurements of available bone width, height, and length. Mandibles were first scanned with a CBCT device in an ideal position with the occlusal plane parallel to the horizontal plane. Then, images of the mandibles were obtained in rotation, tilt, flexion, and extension positions using 5- and 10-degree angulations. Measurements were done on a total of 54 images. Original dimensions of the available bone for planned implant sites were measured with a digital caliper on dry mandibles as the gold standard. The absolute values of the differences between each measurement and the gold standard were obtained for measurement errors. Repeated-measures analysis of variance and Dunnett's multiple comparisons test were used for comparisons (P = .05). Intraobserver and interobserver agreement was calculated using intraclass correlation coefficient (ICC). ICC was excellent for both intraobserver and interobserver reproducibility. No significant difference was found between length and height measurements in ideal position and in rotation, tilt, flexion, and extension movements of mandibles at two different angulations (P > .05). Width measurements revealed a significant difference among ideal measurements and measurements at 10-degree flexion, 10-degree extension, 10-degree rotation, and 10-degree tilted mandibular positions (P < .05). The position of the occlusal plane with respect to the floor during the CBCT scan may have a clinically significant effect on dental implant site dimensions.

To compare dental plaster model (DPM) and cone-beam computed tomography (CBCT) in the measurement of the dental arches, and investigate whether CBCT image artifacts compromise the reliability of such measurements. Twenty patients were divided into two groups based on the presence or absence of metallic restorations in the posterior teeth. Both dental arches of the patients were scanned with the CBCT unit i-CAT, and DPMs were obtained. Two examiners obtained eight arch measurements on the CBCT images and DPMs and repeated this procedure 15 days later. The arch measurements of each patient group were compared separately by the Wilcoxon rank sum (Mann-Whitney U) test, with a significance level of 5% (α = .05). Intraclass correlation measured the level of intraobserver agreement. Patients with healthy teeth showed no significant difference between all DPM and CBCT arch measurements (P > .05). Patients with metallic restoration showed significant difference between DPM and CBCT for the majority of the arch measurements (P > .05). The two examiners showed excellent intraobserver agreement for both measuring methods with intraclass correlation coefficient higher than 0.95. CBCT provided the same accuracy as DPM in the measurement of the dental arches, and was negatively influenced by the presence of image artifacts.

Fractures of the humeral medial epicondyle occur frequently in children. The decision to pursue operative or nonoperative treatment often hinges on the amount of perceived fracture displacement. This study was performed to assess both intraobserver and interobserver agreement in the measurements of displacement of these fractures on radiographs by orthopaedic surgeons with various levels of training. We performed a retrospective review of the radiographs of thirty-eight patients with a fracture of the medial epicondyle of the humerus. Digital anteroposterior, lateral, and oblique radiographs of each involved elbow made at presentation were presented to five separate reviewers with different levels of orthopaedic training, including two junior residents (junior residents 1 and 2), one fellow, one junior attending surgeon, and one senior attending surgeon. Each reviewer recorded the amount of perceived displacement in millimeters. A difference of >2 mm between measurements represented clinical disagreement between reviewers. Intraobserver and interobserver agreement was assessed by calculating both the intraclass correlation coefficient and the percentage of clinical disagreement between ratings. The intraclass correlation coefficients for intraobserver agreement regarding the measurements on the anteroposterior radiographs were 0.24 (95% confidence interval, 0.00 to 0.68) for junior resident 1, 0.82 (95% confidence interval, 0.41 to 0.95) for junior resident 2, 0.83 (95% confidence interval, 0.46 to 0.96) for the senior attending surgeon, 0.92 (95% confidence interval, 0.69 to 0.98) for the junior attending surgeon, and 0.98 (95% confidence interval, 0.92 to 1.00) for the fellow. The combined intraclass correlation coefficient for intraobserver agreement was 0.76. The reviewers as a group disagreed with their own measurements an average of 26% of the time. The intraclass correlation coefficient for interobserver reliability with regard to the measurements on the anteroposterior radiographs for the group was 0.80 (95% confidence interval, 0.64 to 0.89), and the reviewers disagreed with each other an average of 54% of the time. The intraclass correlation coefficient for interobserver agreement was 0.28 (95% confidence interval, 0.03 to 0.76) for the measurements on the lateral radiographs and 0.62 (95% confidence interval, 0.34 to 0.89) for the measurements on the oblique radiographs, with reviewers disagreeing an average of 87% of the time with regard to the measurements on the lateral radiographs and 64% of the time with regard to the measurements on the oblique radiographs. Intraobserver agreement with regard to measurement of displacement of medial epicondyle fractures of the humerus varied among the reviewers but was low overall. Interobserver agreement was best for the measurements on the anteroposterior radiographs, but this was also low overall. These findings cast doubt on whether the amount of perceived displacement should be used as a criterion for choosing operative or nonoperative management of fractures of the humeral medial epicondyle. Agreement may be improved to acceptable levels by adopting a standard set of measurement guidelines, which include use of the anteroposterior radiograph when possible and consistently measuring at the point of maximal displacement.

ObjectiveSince the introduction of cone-beam computed tomography (CBCT) in dentistry, this technology has enabled distortion-free three-dimensional cephalometric analysis for orthodontic and orthognathic surgery diagnosis. However, CBCT is associated with significantly higher radiation exposure than traditional routine bidimensional examinations for orthodontic diagnosis, although low-dose protocols have markedly reduced radiation exposure over time.The objective of this preliminary feasibility study is to compare the accuracy and diagnostic capabilities of an already-validated three-dimensional cephalometric analysis on CBCT to those of an analysis on 3-T magnetic resonance imaging (3T-MRI) to assess whether the latter can deliver a comparable quality of information while avoiding radiation exposure.Materials and methodsIn order to test the feasibility of three-dimensional cephalometry on 3T-MRI, 18 subjects (4 male; 14 female) with mean age 37.8 ± SD 10.2, who had undergone both maxillofacial CBCT and maxillofacial 3T-MRI for various purposes within 1 month, were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione Ospedale Policlinico Maggiore, IRCCS, Milano, Italy.A three-dimensional cephalometric analysis composed of ten midsagittal and four bilateral landmarks and 24 measurements (11 angular, 13 linear) was performed on both scans using Mimics Research® v. 17.0 (NV, Technologielaan 15, 3001 Leuven, Belgium). Cephalometric analysis was performed twice by two independent orthodontists for each scan, and each orthodontist repeated the measurements 3 weeks later. Statistical analysis was performed with SPSS® 20.00 for Windows (IBM® Corporation, Sommers, NY, USA). A Bland-Altman test for each cephalometric value was performed to assess the agreement between the procedures. The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability. The coefficient of variation was used to evaluate precision.ResultsBoth procedures showed good reliability, with mean intraobserver ICCs of 0.977/0.971 for CBCT and 0.881/0.912 for MRI. The average interobserver ICCs were 0.965 for CBCT and 0.833 for MRI. A Bland-Altman analysis for the cephalometric tracing revealed a similar range of agreement between the two modalities; the bias range (mean ± SD) was − 0.25–0.66 mm (0.174 ± 0.31) for distances and − 0.41–0.54° (0.12 ± 0.33) for angles.ConclusionsWithin the main limitation of this pilot study, that is, the small sample, it is possible to state that cephalometric measurements on 3T-MRI seem to possess adequate reliability and repeatability and that they show satisfying agreement with values measured on CBCTs. An MRI examination does not expose patients to ionizing radiation and could provide an alternative to CBCT for three-dimensional cephalometrics in the future.

Introduction: Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging, and the weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Objective: To compare clinical and WB CBCT assessments of HA in patients with AAFD. Methods: In this prospective study, we included 12 men and 8 women (mean age: 52.2 years, range: 20-88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using Intraclass correlation (ICC). Measurements were compared by paired T-tests, and p-values less than .05 were considered significant. Results: The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5 - 18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9 - 11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3 - 5.0) degrees); Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3 - 7.8) degrees; Tibial axis/Subtalar Joint Angle, 7.0 (CI: 5.3 - 8.8) degrees, and Hindfoot Alignment Angle, 22.8 (CI: 20.4 - 25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87-0.97) and interobserver agreement (ICC range: 0.51-0.88) for all WB CBCT measurements. Conclusion: Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. The different CT measurements were reliable and repeatable, significantly differing from the clinical evaluation of hindfoot valgus alignment.