BackgroundCephalometric landmark annotation is a key challenge in radiographic analysis, requiring automation due to its time-consuming process and inherent subjectivity. This study investigates the application of advanced transfer learning techniques to enhance the accuracy of anatomical landmarks in cephalometric images, which is a vital aspect of orthodontic diagnosis and treatment planning. MethodsWe assess the suitability of transfer learning methods by employing state-of-the-art pose estimation models. The first framework is Detectron2, with two baselines featuring different ResNet backbone architectures: rcnn_R_50_FPN_3x and rcnn_R_101_FPN_3x. The second framework is YOLOv8, with three variants reflecting different network sizes: YOLOv8s-pose, YOLOv8m-pose, and YOLOv8l-pose. These pose estimation models are adopted for the landmark annotation task. The models are trained and evaluated on the DiverseCEPH19 dataset, comprising 1692 radiographic images with 19 landmarks, and their performance is analyzed across various images categories within the dataset. Additionally, the study is extended to a benchmark dataset of 400 images to investigate how dataset size impacts the performance of these frameworks. ResultsDespite variations in objectives and evaluation metrics between pose estimation and landmark localization tasks, the results are promising. Detectron2's variant outperforms others with an accuracy of 85.89%, compared to 72.92% achieved by YOLOv8's variant on the DiverseCEPH19 dataset. This superior performance is also observed in the smaller benchmark dataset, where Detectron2 consistently maintains higher accuracy than YOLOv8. ConclusionThe noted enhancements in annotation precision suggest the suitability of Detectron2 for deployment in applications that require high precision while taking into account factors such as model size, inference time, and resource utilization, the evidence favors YOLOv8 baselines.