Midsagittal Landmarks Research Articles

Accuracy of an automated method of 3D soft tissue landmark detection.

Due to technological advances, the quantification of facial form can now be done via three-dimensional (3D) photographic systems such as stereophotogrammetry. To enable comparison with traditional cephalometry, soft-tissue anatomical landmark definitions have been modified to incorporate the third dimension. Annotating these landmarks manually, however, is still a time-consuming and arduous process. To develop an automated algorithm to accurately identify anatomical landmarks on three-dimensional soft tissue images. Thirty 3dMD images were selected from a private orthodontic practice consisting of 15 males and 15 females between 9 and 17 years of age. The soft-tissue 3D images were aligned along a reference plane to setup a Cartesian coordinate system. Screened by 2 observers, 21 landmarks were manually annotated and their coordinates defined. An automated landmark identification algorithm, based on their anatomical definitions, was developed to compare the landmark validity against the manually identified counterpart. Twenty-one landmarks were analysed in detail. Inter-observer and intra-observer reliability using ICC was >0.9. The average difference and standard deviation between manual and automated methods for all landmarks was 3.2 and 1.64 mm, respectively. Sixteen out of twenty-one landmarks had a mean difference less than 4 mm. The landmarks of greatest agreement (≤2 mm) were mainly in the midline: pronasale, subnasale, subspinale, labiale superius, stomion, with the exception of chelion right. Five linear facial measurements were found to have moderate to good agreement between the manual and automated identification methods. The developed algorithm was determined to be clinically relevant in the detection of midsagittal landmarks and associated measurements within the studied sample of adolescent Caucasian subjects.

Effect of sitting, standing, and supine body positions on facial soft tissue: detailed 3D analysis

Medical imaging techniques require various body positions. Gravity causes changes in the facial soft tissue and acts in different directions according to the position of the head during imaging. The aim of this study was to evaluate the effect of positional changes on the facial soft tissue. The faces of subjects were scanned in the standing, sitting, and supine body positions. Differences in the positions were compared using the root mean square (RMS), mean absolute deviation (MAD), and mean signed distance (MSD). The displacement of 15 midsagittal and 20 bilateral landmarks was evaluated. The RMS, MAD, and MSD values of the sitting–standing comparison were significantly lower than those of the sitting–supine and standing–supine comparisons. There were no significant differences between the sitting–supine and standing–supine comparisons. Sixteen out of 135 measurements (12%) of the midsagittal landmarks and 94 out of 180 (52%) measurements of the bilateral landmarks showed significant displacements among the body positions. These results demonstrate a significant change in the facial soft tissue caused by body position. Furthermore, these data show the different susceptibilities of the facial soft tissue landmarks to the effect of body position along the x, y, and z axes.

Deviation of landmarks in accordance with methods of establishing reference planes in three-dimensional facial CT evaluation.

PurposeThis study aimed to investigate the deviation of landmarks from horizontal or midsagittal reference planes according to the methods of establishing reference planes.Materials and MethodsComputed tomography (CT) scans of 18 patients who received orthodontic and orthognathic surgical treatment were reviewed. Each CT scan was reconstructed by three methods for establishing three orthogonal reference planes (namely, the horizontal, midsagittal, and coronal reference planes). The horizontal (bilateral porions and bilateral orbitales) and midsagittal (crista galli, nasion, prechiasmatic point, opisthion, and anterior nasal spine) landmarks were identified on each CT scan. Vertical deviation of the horizontal landmarks and horizontal deviation of the midsagittal landmarks were measured.ResultsThe porion and orbitale, which were not involved in establishing the horizontal reference plane, were found to deviate vertically from the horizontal reference plane in the three methods. The midsagittal landmarks, which were not used for the midsagittal reference plane, deviated horizontally from the midsagittal reference plane in the three methods.ConclusionIn a three-dimensional facial analysis, the vertical and horizontal deviations of the landmarks from the horizontal and midsagittal reference planes could vary depending on the methods of establishing reference planes.

Comparison of conventional and cone beam CT synthesized cephalograms

To compare cephalometric measurements from synthesized cone beam CT (CBCT) lateral cephalograms using orthogonal and perspective projections with those from conventional cephalometric radiographs and dry skulls. Ten skulls were imaged using CBCT and conventional cephalometry. CBCT volume data were exported in DICOM format and imported in Dolphin 3D (pre-release version). Orthogonal and perspective lateral cephalometric radiographs were created from 3D virtual models. Nine linear and five angular measurements were made in Dolphin at three different times. Three calliper measures of midsagittal landmarks were made directly onto skulls. Perspective and conventional image measurements were corrected for known magnification. Reproducibility of measurements was assessed using multivariate analysis of variance (MANOVA). Linear and angular measurements were compared between image modalities by measurement using a repeated measures MANOVA model. Differences and absolute value of differences between image measurements and skull measurements were assessed using analysis of variance (ANOVA). Measurements were not different between the imaging modalities (P>0.05), except for the mandibular unit length (P=0.01). Linear midsagittal measurements were significantly greater than skull measurements for perspective CBCT and significantly less than skull measurements for conventional images (P=0.003). Precision of orthogonal CBCT midsagittal linear measurements was significantly better than the other modalities (P=0.007). Orthogonal CBCT projections provided more accurate midsagittal skull measurements than perspective CBCT or conventional cephalometric radiographs. CBCT can reproduce conventional cephalometric geometry with similar precision and accuracy. Orthogonal CBCT projections provided greater accuracy of measurement for midsagittal plane dimensions than perspective CBCT or conventional cephalometric images.