Reliability and reproducibility of measurements in cephalometric radiography acquired by a charge-coupled device imaging system

Objective: To evaluate and compare the reliability, reproducibility, and speed of two cephalometric tracing methods computer-aided cephalometric tracing and manual tracing. Materials and Methods: This was an analytical, cross-sectional study. One hundred and three pretreatment cephalometric radiographs were randomly selected from the orthodontics department of a public university. Twelve cephalometric landmarks were identified, and fifteen measurements were calculated both manually and digitally using Vistadent OC software. The reliability of measurements was assessed for each method by applying the intraclass correlation coefficient (ICC). Paired t-test was used to compare the measurements' reproducibility and time difference between the two methods. Results: All angular and linear measurements for both the methods showed a range of moderate correlation (0.8 ≥ ICC ≥0.5) to strong correlation (ICC ≥0.8) except for L1-MAD, which displayed a poor correlation for both manual and digital tracing, (ICC = 0.36 and 0.33, respectively), as well as digital tracing of interincisal angle (ICC = 0.36). No statistically significant differences between the two methods were observed for all angular and linear measurements except upper anterior facial height (UAFH) and lower anterior facial height (P = 0.000). There was a statistically significant time difference between the two techniques (P = 0.000). The mean tracing time of the operator for single tracing was 18.02 min for manual tracing and 8.85 min when using the Vistadent program. Conclusion: Cephalometric measurements in conventional manual and digital cephalometric analysis are highly reliable. Although the reproducibility of some measurements between two methods showed statistically significant differences, most differences were considered minimal and clinically acceptable. Computer-assisted cephalometric analysis proved to be more time-efficient.